Job Description
Evaluate pre‑approval requests for medical necessity based on the provided medical data, and accurately code service descriptions according to accepted medical coding rules, medical guidelines, and the policy schedule of benefits.
Respond to Insurance/TPA queries promptly and coordinate with the concerned departments without delay.
Receive, evaluate, and escalate second‑opinion cases and case management as required.
Perform night‑shift duties and work on public holidays as per the duty roster.
Prepare daily activity reports as requested by management and assist with monthly reports.
Handle the auditing process, arrange required documents, and coordinate with coders to support external auditors.
Attend meetings and presentations as required.
Train front office staff, receptionists, and nurses, and keep them updated on insurance details.
Prepare cost estimates for procedures for cash patients.