Approval Officer

About the role

The Approval Officer evaluates pre‑approval requests for medical services, ensuring accurate coding and compliance with insurance policies. The role involves interaction with insurers, internal departments, and external auditors.

Key responsibilities

• Evaluate pre‑approval requests and code service descriptions according to ICD, CPT, DRG, and HCPCS guidelines.
• Respond to insurance/TPA queries and coordinate with relevant departments promptly.
• Handle second‑opinion cases, case management, and escalation as needed.
• Perform night shifts and work on public holidays according to the roster.
• Prepare daily and monthly activity reports for management.
• Support auditing processes by arranging documents and liaising with coders and external auditors.
• Train front‑office staff, receptionists, and nurses on insurance details.
• Prepare cost estimates for cash patients and manage pending cases across shifts.

Required profile

• MBBS degree from a recognized university.
• Minimum 2 years of experience in insurance claims management or adjudication.
• Proficiency in medical coding (ICD, CPT, DRG, HCPCS).
• Excellent oral and written English communication skills.
• Ability to work under pressure and adapt to flexible schedules.

Required skills

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