Medical Officer

Roles and responsibilities:

• Dealing with patients health care related documents.
• Ensuring error free processing of preauthorisation within agreed TAT (Turnaround time).
• 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.
• 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.

Skills and Competencies:

• Medical practitioner/BDS/BHMS/BAMS or equivalent qualification
• 0-1 year experience in Pre-Authorization and Clams management.
• Sound medical knowledge and willing to work in non-clinic process.
• Experience in handling authorization is a add on.
• Should be willing to work in shifts as the department works on 24/7 function