Approval Officer

• Evaluate pre-approval requests for medical necessity based on the clinical information provided.
• Accurately code service descriptions stated in prior authorization requests in accordance with accepted medical coding rules, medical guidelines, and the policy schedule of benefits.
• Respond promptly to Insurance/TPA queries and coordinate with the concerned departments for timely resolution.
• Receive, evaluate, and escalate second-opinion cases and case management matters as required.
• Perform night shifts and public holiday duties as per the approved duty roster.
• Prepare daily activity reports as required by management and assist with the preparation of monthly reports.
• Handle the auditing process by arranging required documents and coordinating with coders to support external auditors.
• Attend meetings and presentations as required.
• Conduct training sessions for Front Office, Reception, and Nursing staff and keep them updated on insurance-related requirements and processes.
• Prepare cost estimates for procedures for cash-paying patients.
• Adjust and manage duties in the event of sudden or emergency unplanned leave of colleagues.
• Manage and hand over pending cases to colleagues in the next shift to ensure continuity of work.
• Perform any other duties assigned by the HOD within the scope of the job role.
• Comply with all OSH and infection control policies, standards, and procedures.
• Follow documented OSH procedures, instructions, and assigned responsibilities.
• Maintain familiarity with emergency and evacuation procedures.
• Report OSH hazards, incidents, near misses, and other safety-related issues promptly.
• Assist with the preparation of risk assessments and incident reports.
• Comply with waste management policies and procedures.
• Attend applicable OSH and infection control training programs, mock drills, and awareness programs.
• Ensure appropriate use of personal protective equipment (PPE) and safety systems.

Desired Candidate Profile

• Bachelor’s Degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years of experience in Insurance Claims Management/Adjudication.
• Proficiency in Medical Coding, including ICD, CPT, DRG, and HCPCS.
• Excellent command of spoken and written English.
• Flexible and able to work effectively under pressure.
• Excellent knowledge of Microsoft Office applications.