Pre-Approval Officer (OP)

Preapproval and Precertification for claims requiring approval.Monitoring and follow up on prior authorization for outpatient/inpatient services.Evaluate the Pre-Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policys schedule of benefits.Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer.Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution.Prepare cost estimate according to procedures for Cash Patient.Responsible for receiving, evaluating and escalating second opinion cases and case management.Respond to Insurance/ TPA queries adequately and liaise with concerned department without any delay.Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate.Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external AuditorsAttend Meetings and Presentation.Train Front office, Receptionist and Nurses and keep them updated about Insurance details.To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.Managing and handling pending cases (if any) to the next shift colleagues.Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.Perform night shift duty and on public holidays as per duty roster.Reporting trends related to preapproval to reporting TL /Supervisor Job

Medical Background - Nursing /BAMS/BHMS/MBBS/BDS preferred. Experience in Insurance Claims management/adjudication (minimum 2 years)Experiences in Medical Coding ICD, CPT, DRG and HCPCS.Excellent command of oral and written English.Flexible and able to work under pressure.Excellent knowledge of Microsoft applications. Key Performance Indicators (KPI's) Completing the assigned/allocated preapproval claims as per TL/Supervisor >95% quality (error free) to be achieved on given tasks.Strict Adherence to process and protocols of payers and as well organizationMaintain TAT for all approval within 24 to 48 hours .