Pre-approval Officer

2 weeks ago

Chennai, India ACCUMED Full time

Responsible for registration and length of stay (LOS) assignment for all acute care hospitals admissions. Reviews and Discusses with nurses and physicians on denied cases or pending cases. Submits all requests, including required forms and limited documentation when requested, via DHPO/ websites. Notifies Hospitals by written notification of approval, rejection and denial of requests. Applies judgement in reconsideration for appeal of rejected cases.

**Primary Responsibilities**:

- Preapproval and Precertification for claims requiring approval.
- Making Cost estimates according to procedures
- Monitoring and follow up on prior authorization for outpatient/inpatient services
- Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer
- Contacting the payers/TPA for approval related matters. Communicates adequately with external parties.
- Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.
- Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate
- Timely and meets deadlines.
- Reporting trends related to preapproval to reporting TL /Supervisor

**Requirements**:

- Medical Background
- Medical Coding knowledge preferred. Certification will be added advantage
- Fresher for Junior Level post,
- Medical Billing Knowledge with certification will be as well an added advantage.
- Proficient in the software modules. (Microsoft Word and Excel)
- Strong background of various insurance pre-authorization protocols and portals

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