Approval Officer
Key Skills for This Role
Full Job Posting
Duties and responsibilities
- Assess medical pre-approval requests for necessity and code services using medical data, accepted coding rules, medical guidelines, and benefit schedules.
- Respond to insurance and TPA queries and liaise with relevant departments; receive, assess, and escalate second-opinion and case-management matters.
- Work night shifts and public holidays according to the duty roster; prepare daily activity reports and assist with monthly management reports.
- Support external audits by arranging documents and coordinating with coders; attend meetings and presentations.
- Train front-office staff, receptionists, and nurses on insurance details.
- Prepare procedure cost estimates for cash patients; cover sudden colleague absences and hand pending cases over between shifts.
- Perform other duties assigned by the HOD within the scope of the role.
Qualifications and experience
- Bachelor's degree in Medicine (MBBS) from a recognized university.
- At least two years of experience in insurance claims management or adjudication.
- Experience in medical coding, including ICD, CPT, DRG, and HCPCS.
- Excellent command of written and spoken English; flexibility and ability to work under pressure.
- Excellent knowledge of Microsoft applications.
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