Approval Officer

Apply medical knowledge and best insurance practice while reviewing and verifying the PreApproval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients.

Responsibilities

• Verifies customers insurance eligibility and authorization in a timely and accurate manner.

• Communicates payer authorization and eligibility information.

• Sends payer informational correspondence.

• Completes service and procedure authorizations and referrals.

• Reviews the patients medical history and insurance coverage for approval.

• If necessary, contacts referral physicians for more information.

• Once approval is obtained, notifies the concerned staff and treating physicians.

• Enters new patient information and updates data in the system.

• Assists with other clerical responsibilities as needed.

• Notifies branch management of concerns regarding payer coverage or service non-coverage.

• Keeps track of the daily production report.

• Keeps the pending approval monitoring system updated for the next days follow-up.

• The supervisor and team leader monitor schedules, emergency requirements and all queries from the facility.

• Guides doctors and concerned staff to follow the correct ICD, CDT and CPT codes to avoid rejections.

Qualifications

• Diploma in any medical discipline or a related field.

• Knowledge of medical coding standards, including ICD, CPT, DRG and HCPCS.

• Minimum 2 years of experience in insurance claims management or pre-authorization processes.