Medical Officer (BHMS, BDS & BAMS)

• Ensuring error free processing of Pre Authorization within agreed TAT (Turnaround time) by way of following the following process,

• By entering

accurate information into the application defined by the organization.

• Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures defined by the insurer and the organization.

• Inform providers as needed and file completed precertification requests as per procedures o Interacting with providers for discharge summery etc.. as and when required.

• Ensure 100% accuracy of all the authorization approval as per the process.

• Any authorization not as per the limit or as per the process to be escalated to the team manager on priority.

• Any medical opinion required from the specialist to be escalated to the specialist.

• Ensuring process compliance is met as per regulatory procedures.

• Maintaining Daily excel maintenance for Pre auth cases received and processed.

• Solving customer queries wherever medical opinions are required and need to be address by the medical practitioner Preferred Skills/Tools: