Pre-Approval Officer

Job Description

What You Will Do

• Review all claim forms which is assigned on the dashboard and provide adequate feedback on the same.
• Update Approvals received from Insurance companies with 100% accuracy
• Communicating with departments in case of any missing document or more information required
• -Meet daily claims verification productivity
• -Quantitative analysis – Perform a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
• Follows coding guidelines and legal requirements to ensure compliance with regulatory guidelines
• Qualitative analysis – Evaluate the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review the records for compliance with established third party reimbursement agencies and special screening criteria
• Receive the patient medical record on daily basis and check any deficiency in documentation, if any, notify the concerned staff and send it to physician
• Receive the completed records and ensure that the marked deficiencies are cleared and follow the standards
• Timely submissions of all preapprovals as per KPIs
• Improve the quality of pre-approval submission to obtain approval from the first round.
• The role also include stop revenue loss through monitoring and coordination with all concerned stakeholders like coding team and physicians to revise IC rejections.
• Monitor behavioural approval processes of various payors and corporates to apply customized actions to obtain pre-approvals.
• Ensure all pre-approvals are submitted of all eligible IP,OP and pharmacy to IC/TPA
• Internal Follow up for additional information required by insurance company
• Interacting with the physicians for the clinical justification of the pre=approvals.
• Ensure and work closely with the team on complex cases to obtain faster approval from payers.
• Making sure that PAR submissions are dealt with according to Insurance industry and DHA regulations.
• Comply with pre-approval KPI’s (Key Performance Indicator) , maintain a record of pre-approval KPIs as and when required.
• Educate billing/Approval team to enhance the process flow.
• Ensures that targets are met within turnaround time and while maintaining quality and productivity.
• Coordinate with CDI team to educate the physicians , and other paramedical team to ensure proper claims documentations.
• Maintain accurate monthly data of claims submissions of each insurance company
• Coordination with other business stakeholders to improve overall submission process efficiency.
• Analysis of financial data related to revenue cycle, to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risk/s .
  

Required Skills To Be Successful

• Strong medical background to handle reconciliation efficiently.
• Strong Negotiation skills
• Strong soft skills
  

About The Team

The role will report to the Revenue Cycle Manager, The Pre-Approval will assist the review and and update of claims and approvals received from the insurance companiesm, serves as a point of contact between the revenue cycle department and the medical staff in the clinics.

What Equips You For The Role

• Minimum 3+ years’ experience in a similar role.
• Certified professional coding certificate from reputed institution