The Operations Department is responsible to manage all aspects of claims management including Onsite operations and back end processing. The department primarily works on main objective of submitting the claims in time with highest quality to ensure the client receives the payment with minimal or no rejections.

Role Summary

Preapproval Department is based at the hospital site which manages precertification for all IPD and OPD cases for insured members contracted with the hospital as per designated networks.

Major role is at seeking preapproval for services with patient satisfaction-oriented duties.

The Associate Pre-Approval is responsible for registration and length of stay (LOS) assignment for all acute care hospitals admissions. Reviews and Discusses with nurses and physicians on denied cases or pending cases. Submits all requests, including required forms and limited documentation when requested, via DHPO/ websites. Notifies Hospitals by written ...