- Follows policies and procedures of the department.
- Reviews accuracy and completeness of information requested and ensure that all supporting documents are present for an insurance claim.
- Receives requests for pre-authorizations and ensure that they are properly and closely monitored and pre-authorizations for the claim secured as per the payer protocols.
- Consults with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
- 1-2 years experience in preapproval authorisation services at clinic or hospital facility.
- Usage and Basic Knowledge of (ICD 10 AM/CM with CPT and HCPCS).
- Previous experience with usage of medical terminologies.
- Previous experience of communication with all the payers /TPA in the region.
- Able to work in shifts, weekends and on public holidays with extended hours based on work requirements.
Qualification
Essential:
1-2 years experience in the region in preauthorisation field.
Preferred:
Medical Graduation such as Nursing, Dentist, MBBS, Pharmacist or Physiotherapist