Approval Officer

Job Description Roles & Responsibilities JOB SUMMARY Apply medical knowledge and best insurance practices while reviewing and verifying Pre-Approval requests (OP/IP) received from different departments to obtain authorizations as required by insurance companies, depending on the plan coverage for all insurance patients. Ensure that Pre-Authorization Requests comply with regulatory standards, particularly claim adjudication rules and business rules. Handle rejected Pre-Authorization requests and obtain the required justification from the treating doctor for resubmission to the insurance company and approval. Prepare daily activity reports as requested by management and assist with month-end reporting as required. DUTIES AND RESPONSIBILITIES Evaluate Pre-Approval requests for medical necessity based on the medical information provided. Accurately code service description codes stated on prior authorization requests in accordance with accepted medical coding rules, medical guidelines, and the policy schedule of benefits. Respond to Insurance/TPA queries and liaise with concerned departments without delay. Receive, evaluate, and escalate second-opinion cases and case management requirements as appropriate. Prepare daily activity reports and assist with monthly reporting as required. Attend meetings and presentations as required. Adjust and manage duties in the event of sudden, emergency, or unplanned leave of colleagues to ensure continuity of operations. Manage and hand over pending cases, if any, to colleagues in the next shift. Perform any other duties or responsibilities assigned by the HOD from time to time within the scope of the job title. Desired Candidate Profile Bachelor’s degree in Medicine or an equivalent medical degree from a recognized university. Minimum 2 years of experience in insurance claims management/adjudication. Knowledge of medical coding systems, including ICD, CPT, DRG, and HCPCS. Excellent command of both written and spoken English. Flexible and able to work under pressure and in shifts. Proficiency in Microsoft Office applications Employment Type Full-time Company Industry MedicalHealthcareDiagnosticsMedical Devices Department / Functional Area DoctorNurseParamedicsHospital TechniciansMedical Research Keywords Financial AnalysisReport PreparationData ManagementProcess ImprovementCross-Functional CollaborationTraining And DevelopmentRisk ManagementStakeholder Engagement Get real-time job updates only on our App