Approval Officer

About the role

The Approval Officer ensures that pre‑authorization requests for medical procedures are accurately reviewed, coded, and submitted to insurance companies in compliance with regulatory and policy guidelines. Working within the Royal Medical Centre Shahama, you will coordinate with clinical and administrative teams to secure timely approvals for patients.

Key responsibilities

• Review and verify pre‑approval (OP/IP) requests, ensuring alignment with insurance plans and claim adjudication rules.
• Handle rejected authorizations by obtaining justification from treating physicians and resubmitting to insurers.
• Code services using ICD, CPT, DRG, and HCPCS standards.
• Respond to insurer/TPA queries and coordinate with relevant departments for swift resolution.
• Prepare daily activity reports and support month‑end reporting.
• Assist with audits by providing documentation and liaising with coders.
• Conduct training for front‑office, reception, and nursing staff on insurance processes.
• Manage night shifts, public holidays, and emergency handovers as per roster.

Required profile

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

Required skills

• ICD coding
• CPT coding
• DRG coding
• HCPCS coding
• Microsoft Office applications