Approval Officer

About the role

The Approval Officer ensures that all pre‑authorization requests for medical procedures are reviewed, coded, and processed in line with insurance policies, regulatory standards, and hospital guidelines. This role supports both inpatient and outpatient departments, handling queries, re‑submissions, and reporting to maintain smooth insurance workflows.

Key responsibilities

• Review and verify pre‑approval requests (OP/IP) from various departments, ensuring compliance with insurer coverage and regulator standards.
• Handle rejected authorizations, obtain clinical justification, and resubmit to insurers for approval.
• Prepare daily activity reports and assist with month‑end reporting for management.
• Evaluate medical necessity and accurately code services using ICD, CPT, DRG, and HCPCS.
• Respond promptly to insurer/TPA queries and coordinate with relevant departments for timely resolution.
• Manage second‑opinion cases, case‑management escalations, and night‑shift/public‑holiday duties as scheduled.
• Support audit processes by providing required documentation and coordinating with coders.
• Conduct training for front‑office, reception, and nursing staff on insurance procedures.
• Prepare cost estimates for cash‑paying patients and ensure proper hand‑over of pending cases between shifts.
• Maintain compliance with OSH and infection‑control policies, report hazards, and participate in safety training.

Required profile

• Bachelor’s degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years of experience in insurance claims management or adjudication.
• Proficiency in medical coding, including ICD, CPT, DRG, and HCPCS.
• Excellent spoken and written English.
• Ability to work under pressure with a flexible schedule.

Required skills

• Medical coding (ICD, CPT, DRG, HCPCS)
• Microsoft Office applications