Handling the rejected pre-authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval. Prepares reports of daily activity as requested for management and assists management in month end reporting as requested.
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 policy's schedule of benefits.
Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
High School Diploma/ Bachelor's degree
* 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 …
* 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…
* Apply medical knowledge and best insurance practice while reviewing and verifying the Pre-Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details…
* Ensuring coverage of claims, guiding staff for correct use age of claim forms, approval papers. * Getting approval for medical procedures. * Coordinating with insurance companies for obtaining information on new policies and their coverage. * Explaining coverage of medical benefits to pa…
* Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details…
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