: * 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 allthe 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 departmentResponsibilities: * 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 allthe 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 departmentQualifications: * 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.