Approval Officer

About the role

The Approval Officer will apply medical knowledge and insurance best practices to review and verify pre‑approval requests (outpatient/inpatient) from various departments, ensuring compliance with insurer and regulator rules.

Key responsibilities

• Evaluate pre‑approval requests for medical necessity and accurately code service descriptions according to accepted coding rules and policy schedules.
• Respond promptly to insurer/TPA queries and liaise with relevant departments.
• Handle rejected authorizations, obtain justification from treating doctors, and resubmit for approval.
• Receive, evaluate, and escalate second‑opinion cases and case‑management requirements.
• Prepare daily activity reports and assist with month‑end reporting as required.
• Attend meetings and presentations related to authorization processes.
• Cover sudden or emergency leaves of colleagues and hand over pending cases to the next shift.
• Perform any other duties assigned by the Head of Department.

Required profile

• Degree or certification in health administration, medical coding, or a related field.
• Strong understanding of insurance claim adjudication and regulatory standards.
• Experience reviewing pre‑authorization requests in a hospital or similar healthcare setting.
• Excellent attention to detail and ability to work under tight deadlines.
• Effective communication skills for interaction with doctors, insurers, and internal teams.

Required skills

• Medical coding (ICD‑10, CPT).
• Knowledge of insurance policies and claim adjudication rules.
• Proficiency in preparing activity and management reports.
• Ability to use hospital information systems for authorization processing.