Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details of the Pre Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
Handling the rejected pre authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.
Prepares reports of daily activity as requested for management and assists management in month end reporting as requested.
