Approval Officer

Apply medical knowledge and best insurance practices while reviewing and verifying pre-approval requests (OP/IP) received from different departments to obtain authorizations as required by insurance companies, based on the patient’s insurance plan coverage. Ensure that all pre-authorization request details comply with regulatory standards, especially claim adjudication rules and business rules. Handle rejected pre-authorization requests by obtaining the required justification from the treating doctor, resubmitting the request to the insurance company, and securing approval. Prepare daily activity reports as requested by management and assist with month-end reporting requirements.