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, and ensure that the details of the Pre‑Authorization Requests are in line with regulators standards especially the claim adjudication Rules and Business Rules.
Handle the rejected pre‑authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.
Prepare reports of daily activity as requested for management and assist management in month end reporting.
Evaluate the Pre‑Approval requests for 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 codi...