Job Description

Job Category: Administration
:
0 DUTIES AND RESPONSIBILITIES
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.
Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
Responsible for receiving, evaluating and escalating second opinion cases and case management.
Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
Attend Meetings and Presentation.
To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
Managing and handling pending cases (if any) to the next shift colleagues.
Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
Responsibilities:
DUTIES AND RESPONSIBILITIES
Evaluate the Pre-Approval requests for medical necessity of 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.
Respond to Insurance/TPA queries and liaise with the concerned department without any delay.
Responsible for receiving, evaluating, and escalating second opinion cases and case management.
Prepare reports of daily activity as requested for management and assist management in monthly reports as required.
Attend meetings and presentations.
Adjust duties in case of any sudden or emergency unplanned leaves by colleagues.
Manage and handle pending cases (if any) and hand them over to the next shift colleagues.
Perform any other jobs or duties assigned by the HOD from time to time within the scope of the job title.
Qualifications:
QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS
4.1 Bachelor degree in medicine or equivalent medical degree for recognized university.
4.2 Experience in Insurance Claims management/adjudication (minimum 2 years).
4.3 Knowledge in Medical Coding ICD, CPT, DRG and HCPCS.
4.4 Excellent command of oral and written English.
4.5 Flexible and able to work under pressure and in shifts.
4.6 Excellent knowledge of Microsoft applications.

Skills Required