Approval Officer
Skills
About This Role
Overview
Responsible for reviewing clinical documentation and assigning standardized medical codes to diagnoses, procedures, and treatments for billing, insurance claims, and maintaining accurate medical records.
Responsibilities
- Follow the mandatory SOP, checklist and relevant payer and coding guidelines.
- Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)
- Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.
- Supporting details/ justification available in EMR of all investigation done.
- Checking all CPT codes entered are correct based on CPT guidelines.
- Checking excluded ICD and CPT based on Coding guidelines.
- Approved services and rendered services are match.
- Ensuring all requested investigations are done and invoiced.
- Check the claim with correct Receiver and Payer name before finalizing the bill.
- Check the claim with correct Patient Copay application.
- Ensure all claims are submitted to insurance company.
- Check the payer’s name, rate plan and plan name selected properly.
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