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
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
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
QUALIFICATIONS
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
It is observed that some people start their job from lower ranks and remain in lower ranks for the long period of time while others start their job in lower ranks and use that low rank as their launching pad and start flying in a very short time. Actually the people who got rapid promotion have some capabilities and one could develop those capabilities in him so that he could get the rapid promotion in the job. Some of these capabilities are mentioned here under:
Continuously improve the qualification: It is the best tool which could come to help you to progress in your rank to have the higher qualifications. No doubt learning with earning is not an easy job. But once you get determined than you could get the task done in desired way.
Keenly observe the field and try to understand the technical tasks: It is observed that those people rise in their rank that could handle the technical aspects of their job in right way. Therefore, it is suggested to keep those secrets of job with you as soon as possible.
Try to show your worth to higher authorities: After getting good qualification and knowing the technical aspects of your job, it is good idea to give a good presentation to higher authorities so that you could get entered your name in the good book of higher authorities. In this way you could get the big boost in the promotion.