Job Description:

• Approval Management: Submit and follow up on IP/OP, Day Case (DC), and Long-Term Care (LTC) pre-approvals within designated timeframes.
• Insurance Coordination: Liaise between hospitals/clinics and insurance companies/TPAs to secure authorization for medical services.
• Medical Coding & Documentation: Review medical files to ensure medical necessity, applying accurate ICD-10 or CPT codes according to policy guidelines.
• Reconsideration & Appeals: Re-evaluate and resubmit rejected cases, providing justification to payers.
• Communication: Coordinate with doctors, nurses, and administrative staff for necessary clinical documentation.
• Reporting: Prepare daily, weekly, or monthly reports on approval status, pending cases, and rejection rates. 
   

• Knowledge: Strong understanding of insurance protocols, medical terminology, and coding systems (ICD-10, CPT).
• Experience: Previous experience in a hospital billing or insurance department, typically 1–5+ years.
• Communication: Excellent verbal and written skills for dealing with insurers and medical staff.
• Analytical Skills: Ability to identify issues in rejected claims and provide quick resolutions.
• Technical Skills: Proficiency in Hospital Information Systems (HIS) and Microsoft Office. 

Industry:

HealthCare

Category:

Health

Skills: