Medical Officer- TPA

Key Objectives/Responsibilities of this Role: • 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: • Medical practitioner/BDS/BHMS/BAMS or equivalent qua