Description

Job Description

Description

 Apply medical knowledge and best insurance practice while reviewing and verifying the PreApproval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients.

Responsibilities

• 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 codesto avoid the rejection

Qualifications

• 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