Responsibilities

• Evaluate Pre‑Approval requests from medical necessity, accurately coding the service description codes stated on prior authorization requests, according to accepted medical coding rules, medical guidelines, and policy schedule of benefits.
• Respond to Insurance/TPA queries and liaise with concerned departments without delay.
• Receive, evaluate, and escalating second opinion cases and case management.
• Perform night shift duty and on public holidays as per duty roster.
• Prepare daily activity reports for management and assist in monthly reports as requested.
• Handle auditing process by arranging required documents and checking with coders to assist external auditors.
• Attend meetings and presentations.
• Train front office, receptionists, and nurses on insurance details.
• Prepare cost estimates for procedures for cash patients.
• Adjust duties in case of any sudden/emerg...