The posting
Job 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.
- Completes service and procedure authorizations and referrals.
- Reviews the patient's medical history and insurance coverage for approval.
- If necessary, contacts referral physicians for more information.
- Once approval is obtained, notifies the concerned staff and treating physicians.
- Enters new patient information and updates data in the system.
- Assists with other clerical responsibilities as needed.
- Notifies branch management of concerns regarding payer coverage or service non-coverage.
- Keeps track of the daily production report.
- Keeps the pending approval monitoring system updated for the next day's follow-up.
- The supervisor and team leader monitor schedules, emergency requirements and all queries from the facility.
- Guides doctors and concerned staff to follow the correct ICD, CDT and CPT codes to avoid rejections.
Qualifications
- Diploma in any medical discipline or a related field.
- Knowledge of medical coding standards, including ICD, CPT, DRG and HCPCS.
- Minimum 2 years of experience in insurance claims management or pre-authorization processes.



