Insurance Coordinator
1 day ago
We are seeking a detail-oriented and knowledgeable
Pre-Approvals Officer
to join our team at
. In this role, you will play a critical part in ensuring seamless pre-authorization processes for insurance patients, while adhering to regulatory standards and best practices. The ideal candidate will have a strong background in medical insurance, coding, and claims adjudication, along with excellent communication and problem-solving skills.
Key Responsibilities:
Pre-Authorization Management:
Review and verify pre-approval requests (OP) from various departments to ensure compliance with insurance company requirements and regulatory standards, including claim adjudication rules and business rules.
Evaluate pre-approval requests for medical necessity, ensuring accurate coding of service descriptions in line with medical guidelines, coding rules, and policy schedules.
Rejection Handling and Reporting:
Address rejected pre-authorizations by obtaining necessary justifications from treating doctors and resubmitting requests to insurance companies for approval.
Prepare daily activity reports and assist management with month-end reporting as required.
Insurance Liaison and Auditing:
Respond promptly to insurance/TPA queries and coordinate with relevant departments to resolve issues efficiently.
Handle the auditing process to ensure compliance and accuracy in pre-authorization activities.
Training and Support:
Train and update front office staff, receptionists, and nurses on insurance-related processes and updates.
Prepare cost estimates for corporate insurance patients and manage pending cases effectively.
Additional Duties:
Perform other tasks as assigned by the Head of Department (HOD) within the scope of the role.
Qualifications:
Proven experience in medical insurance, pre-authorization, or claims adjudication.
Strong knowledge of medical coding, regulatory standards, and insurance practices.
Excellent communication, organizational, and problem-solving skills.
Ability to work in a fast-paced environment and manage multiple tasks efficiently.
Proficiency in Microsoft Office and relevant healthcare software.
Why Join Us
At
, we are committed to providing exceptional healthcare services while fostering a collaborative and supportive work environment. Join us and contribute to a team that values professionalism, innovation, and patient care.
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