Medical Officer

Position Description

Skills and Competencies

The team of medical practitioner part of Pre-Authorization team will use their skills and expertise in authorizing the request received and they will ensure that the customers are attended on time by following the protocol of the policy defined by the insurer and the organization.

Ensuring error free processing of preauthorisation within agreed TAT (Turnaround time) by way of following the following process, o By entering accurate information into the application defined by the organization. o 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. o Inform providers as needed and file completed precertification requests as per procedures o Interacting with providers for discharge summery etc.. as and when required.

Medical practitioner/BDS/BHMS/BAMS or equivalent qualification

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.

0-3 years experience in Pre-Authorization and Claims management.

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

Sound medical knowledge and willing to work in non clinic process.

Ensuring process compliance is met as per regulatory procedures.

Minimum of one year experience in handling authorization (preferred)

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

Should be willing to work in shifts as the department works on 24/7 function

Solving customer queries wherever medical opinions are required and need to be address by the medical practitioner

Should be willing to work from office (no WFH)Role & responsibilities

Preferred candidate profile