Job Description

Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy's schedule of benefits

Response to Insurance/ TPA queries and liaise with concerned department.

Responsible for receiving, evaluating and escalating second opinion cases and case management

Perform night shift duty to sustain any issues and queries related to Authorization department

Prepares reports of daily activity as requested for management and assists management in monthly reports as requested

GENERAL RESPONSIBILITIES:

Work in all shifts as scheduled by the Head of Department.

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Strictly adheres to organization's regulations and policies especially those related to infection control, patient safety, OSHMS, DOH, JCI and ISO.


Supports Continuous Quality Improvement and participates and contributes to all the quality assurance activities of the service.


Participates and contributes in scheduled in-service training programs. Exercises effective interpersonal skills in dealings with department staff, associates and Management.


Maintains confidentiality as per the agreement signed. Demonstrates the ability to listen to others in promoting effective communication. Develops thorough understanding of policies and procedures of the hospital and demonstrates respect for them.


Carries out other duties when requested by the Head of department

Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy's schedule of benefits

Response to Insurance/ TPA queries and liaise with concerned department.

Responsible for receiving, evaluating and escalating second opinion cases and case management

Perform night shift duty to sustain any issues and queries related to Authorization department

Prepares reports of daily activity as requested for management and assists management in monthly reports as requested

GENERAL RESPONSIBILITIES:

Work in all shifts as scheduled by the Head of Department.

+
Strictly adheres to organization's regulations and policies especially those related to infection control, patient safety, OSHMS, DOH, JCI and ISO.


Supports Continuous Quality Improvement and participates and contributes to all the quality assurance activities of the service.


Participates and contributes in scheduled in-service training programs. Exercises effective interpersonal skills in dealings with department staff, associates and Management.


Maintains confidentiality as per the agreement signed. Demonstrates the ability to listen to others in promoting effective communication. Develops thorough understanding of policies and procedures of the hospital and demonstrates respect for them.


Carries out other duties when requested by the Head of department

Bachelor Degree in Medicine (MBBS) graduate from a recognized university. Experience in Insurance Claims management/adjudication (minimum 2 years) Experience in Medical Coding ICD, CPT, DRG and HCPCS. Excellent command of oral and written English. Flexible and able to work under pressure * Excellent knowledge of Microsoft applications