Job Description

Handling the rejected pre-authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.

Ensure that the details of the Pre-Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.

• Verifies customers' insurance eligibility and authorization in a timely and accurate manner
• Communicates payer authorization and eligibility information.
• Sends payer informational correspondence.
• Complete service and procedure authorizations and referrals
• Review the patient's medical history and insurance coverage for approval.
• If necessary, contact referral physicians for more information.
• Once approval is obtained, the concerned staff and treating physicians should be notified.
• Enter new patient information and update data in our system.
• As needed, assist with other clerical responsibilities.
• Notifies branch management of concerns with payer coverage or other service noncoverage.
• Keep track of the daily production report.
• Keep the pending approval monitoring system updated for the next day's follow-up.
• The supervisor and team leader will monitor the schedules and emergency requirements and all the quires from the facility.

Guide the doctors and concerned staff to follow the correct ICD, CDT and CPT codes to avoid the rejection

• College Diploma - Any discipline or related fields.
• Proficiency in medical coding standards: ICD, CPT, DRG, HCPCS

Experience in insurance claims management or pre-authorization (approval) processes, typically 2+ years