Medical Preauthorization Officer
CurrentEnsure timely review of Pre-Authorization cases and process as per prescribed guidelines and protocols.Responsible for issuing accurate Pre-approvals to the providers and deliver excellent customer service.Take appropriate decision to process pre-approval requests in conjunction with best medical standards and policy terms and conditons.Provide approval for OP & IP admission/medications/ laboratory investigations/maternity, dental and optical cases as per the insurance coverage.Coordinate with provider for pre-approval related queries and negotiate to establish medical neccessities.Review clinical data matching it against specified medical terms and/or diagnosis/procedure codes and follow established procedure for authorizing preapproval request.Reviews case records and reports, evaluates client's medical status and defines needsand problems in order to provide proactive case management services, handleincoming client/provider emails for ongoing/escalated IP cases.Establish effective rapport with other employees and supervisor and maintain cooperative working relationship; actively support departmental activities.Answer calls from pharmacies, providers, and customers using exemplary customer service skills.
