Approval Officer

• Handle rejected pre-authorization and obtain required justification from treating doctor to resend to Insurance Company and obtain approval • Ensure details of Pre-Authorization Requests align with regulators’ standards, claim adjudication Rules and Business Rules • Verify customers' insurance eligibility and authorization in a timely and accurate manner • Communicate payer authorization and eligibility information • Send payer informational correspondence • Complete service and procedure authorizations and referrals • Review patient's medical history and insurance coverage for approval • Contact referral physicians for more information if necessary • Notify concerned staff and treating physicians once approval is obtained • Enter new patient information and update data in system • Assist with other clerical responsibilities as needed • Notify branch management of concerns with payer coverage or other service noncoverage • Keep track of the daily production report • Keep the pending approval monitoring system updated for next day's follow-up • Supervisor and team leader will monitor schedules, emergency requirements and queries from the facility • Guide doctors and concerned staff to follow correct ICD, CDT and CPT codes to avoid rejection • Experience in insurance claims management or pre-authorization (approval) processes (typically 2+ years) • Proficiency in medical coding standards: ICD, CPT, DRG, HCPCS • College Diploma in any discipline or related fields