Authorisation officer
Posted on :
08-05-2024
Employer Active
1 Vacancy
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Job Description
Req ID : 2816841
- Assist Supervisor in ensuring that new guidelines, service/drug coding, updated policies and procedures that are related to duties of the coordinator are being properly implemented
- Evaluate medical necessity of requested services according to medical data provided and accurately code service descriptions/drug codes stated on prior authorisation requests based on accepted medical coding rules/guidelines and policy’s schedule of benefits
- Ensure that proper documentation of the data including business decisions are correctly done on the system with focus on accuracy, efficiency and quality
- Constantly work on improving the TAT and relevant functional and personal competencies
- Handle authorisation related issues/queries of health care providers or customers and providing them with appropriate assistance and guidance
- Assist Supervisor in training new staff as per their function
- Report suspected cases of fraud/abuse by healthcare providers to respective Supervisor
- Evaluate and sign high cost authorisation letters from Medical Authorisation Coordinator as per his authority
- Initiate the resolving of complex situations and issues at the coordinator level and take measures to avoid the reoccurrence of similar incidents
- Handle changes in the workload flow from healthcare providers in terms of time, quantity and type of prior authorisation requests received with clear focus on quality and set target
- Escalate cases needing Case Management intervention based on communicated criteria
- Perform shift duty to ensure 24/7 operations of the department
Employment Type
Full Time
Department / Functional Area
Key Skills
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