Approval Officer

Overview

Responsibilities

• valuate pre-approval requests for medical necessity based on submitted clinical documentation and accurately assign coding for requested services in accordance with accepted medical coding standards, medical guidelines, and policy benefits.
• Respond promptly to insurance companies and TPAs, and coordinate with relevant departments as required.
• Receive, assess, and escalate second-opinion cases and case management requests.
• Perform night shift duties and work on public holidays as per the approved duty roster.
• Prepare daily activity reports and support management with monthly reporting requirements.
• Coordinate and support internal and external auditing processes by arranging required documentation and liaising with coding staff.
• Attend meetings, presentations, and departmental discussions as required.
• Conduct training sessions for front office staff, receptionists, and nurses, ensuring they remain updated on insurance policies and procedures.
• Prepare cost estimates for procedures and services for cash-paying patients.
• Provide coverage and adjust duties during emergency or unplanned staff absences.
• Ensure smooth handover and management of pending cases to subsequent shifts.
• Perform additional duties assigned by the Head of Department within the scope of the role.
• Comply with all Occupational Safety and Health (OSH) and Infection Control policies, procedures, and standards.
• Follow documented OSH procedures and fulfill assigned safety responsibilities.
• Maintain awareness of emergency response and evacuation procedures.
• Report OSH hazards, incidents, near misses, and assist in risk assessments and incident investigations.
• Adhere to waste management policies and procedures.
• Participate in mandatory OSH, Infection Control training programs, mock drills, and awareness initiatives.
• Utilize appropriate personal protective equipment (PPE) and safety systems at all times.