The Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers with high efficiency and within the agreed turnaround time to maintain the team KPIs.
What You Do - Assesses approval of medical approvals as well as policy use.
- Check particular treatment plan is necessary for the patient.
- Inputs verbal and written claims approvals regularly.
- Decide approvals as per policy conditions.
- Assess high-cost claims and provide decisions on high-cost and complicated cases.
- Provide clear feedback on queries from call Centre team.
- Provides clients an understanding of any declined medical claims.
- Coordinates workflow & meet deadlines.
- Evaluate claims concerning eligibility.
- Meet daily Precertification productivity target according to claims type/tenure.
- Adjudi...