Approval Officer – Medical Pre‑Authorization

About the role

The Approval Officer evaluates pre‑approval requests for medical services, codes the service descriptions according to accepted medical coding rules, and ensures compliance with the hospital’s schedule of benefits and policies. The role involves close interaction with insurance providers, third‑party administrators, and internal departments to facilitate timely authorizations.

Key responsibilities

• Assess medical necessity of pre‑approval requests and assign accurate ICD, CPT, DRG, and HCPCS codes.
• Respond to insurance and TPA queries, coordinating with relevant departments without delay.
• Receive, evaluate, and escalate second‑opinion cases and manage case flow.
• Perform night‑shift duties and work on public holidays as per roster.
• Prepare daily activity reports and assist in monthly management reporting.
• Support auditing processes by gathering documents and liaising with external auditors.
• Train front‑office staff, receptionists, and nurses on insurance procedures.
• Prepare cost estimates for cash patients and manage pending cases across shifts.

Required profile

• Bachelor’s degree in Medicine (MBBS) from a recognized university.
• Minimum two years of experience in insurance claims management or adjudication.
• Proficiency in medical coding standards (ICD, CPT, DRG, HCPCS).
• Excellent command of oral and written English.
• Ability to work under pressure and adapt to sudden schedule changes.
• Strong knowledge of Microsoft Office applications.

Required skills

• Medical Coding (ICD, CPT, DRG, HCPCS).
• Insurance Claims Management.
• Microsoft Office (Word, Excel, PowerPoint).