Medical Authorization Officer

Medical Authorization Officer

Policies, Processes & Procedures:

– Follow all relevant departmental policies, processes, standard operating procedures and instructions so that work is carried out in a controlled and consistent manner.

Medical Authorization Activities:

• Verify requests with insurance policy; interpret medical information such as diseases or symptoms, and diagnostic descriptions and recommended procedures for treatment and determine if requested procedures are justified.

– Approve medical authorization requests (as per delegated authority) if they comply with all stipulations and forward them to the Supervisor for final approval.

• Forward approved medical authorization requests to the provider and ensure proper record keeping.
• Handle all calls from Pharmacies or follow up calls on medical authorization.
• Support clients/providers on any medical authorization related queries, follow ups, emails or fax.

Rejection of Authorization Requests:

• Coordinate with Doctors/Providers on medical authorization procedure requests if they are not acceptable and recommend appropriate alternate approaches. Recommend rejection of request for the manager to approve along with justifications.

Reports :

• Provide Management with appropriate reports regarding the unit and compliance with operational policy and procedures.

Other Job-related duties:

• Job descriptions given to the employees provide the general nature and level of work expected. It is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.
• The job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties requested by their departmental manager.
• ADNIC Management reserves the right to assign any responsibilities to its employees based on the business requirements.

KNOWLEDGE,SKILLS & EXPERIENCE:

Minimum Qualifications and Knowledge:

 University degree in Medicine.

Minimum Experience:

2 years of relevant experience (preferably in Insurance industry).