Job Description:

• Authorization Submission: Review and submit pre-authorization requests for IP/OP services via insurance portals, ensuring accuracy according to regulatory standards.
• Medical Evaluation: Review clinical data for medical necessity against payor policies and assign appropriate medical codes (ICD/CPT).
• Rejected Case Management: Handle rejections by liaising with doctors for medical justifications and resubmitting cases to insurers.
• Documentation & Reporting: Prepare daily activity reports, track pre-approval KPIs, and monitor approval timelines to reduce revenue leakage.
• Communication: Act as the main liaison between treating physicians, patients, and TPAs/Insurance companies.
• Cashless Process Management: Guide patients regarding their insurance eligibility, coverage details, and approval status. 
   

• Education: Typically a medical background (Nursing, BAMS, BHMS, MBBS, BDS) is preferred.
• Experience: Previous experience in medical insurance approvals and familiarity with DHA/TPA regulations.
• Skills: Strong knowledge of medical coding, proficiency in medical insurance platforms, excellent communication skills, and attention to detail. gol

Industry:

HealthCare

Category:

Health

Skills: