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Manager Claims Pre Auth

1.00 to 3.00 Years   Hyderabad   11 Jan, 2025
AUDUMBAR ADVERTISING
Job LocationHyderabad
EducationNot Mentioned
SalaryRs 6 - 9 Lakh/Yr
IndustryMedical / Healthcare
Functional AreaOccupational Health / SafetyAllied Health Services
EmploymentTypeFull-time

Job Description

    Job Summary:Seeking a detail-oriented and highly organized Claims Pre-Authorization Specialist to join our team. In this role, you will be responsible for reviewing and processing pre-authorization requests for medical procedures and services, ensuring compliance with insurance policies and guidelines. The ideal candidate will possess strong analytical skills, excellent communication abilities, and a thorough understanding of medical terminology and insurance protocols.Responsibilities:
    • Manage volumes effectively & efficiently to maintain Turnaround time of processing cases Communicate with healthcare providers to obtain additional information or clarification regarding pre-authorization requests, as needed.
    • Evaluate medical necessity and appropriateness of requested services based on established criteria and guidelines. Collaborate with internal teams, including claims processing, customer service, and medical management, to ensure timely and accurate processing of pre-authorization requests.
    • Provide guidance and support to healthcare providers and members regarding pre authorization requirements, coverage policies, and claim submission procedures.
    • Stay informed about updates and changes in insurance policies, regulations, and industry trends related to pre-authorization processes and requirements.
    • Identify opportunities for process improvement and contribute to the development of best practices and workflows related to pre-authorization processing.
    Skill Set required:
    • Should have 1-2 years of experience in Claims Billing Cashless and Reimbursement.
    • Should be a BAMS / BHMS / MBBS Understanding of Policy terms & conditions & Various Protocols / Guidelines, Ailment Wise ICD & Procedure Coding Flexible in Shifts Knowledge of Health Insurance Policy terms & Conditions.
    Desired skills:
    • Good oral and written communication, negotiation and decision-making skills. Knowledge of health insurance claims process / billing.
    • Good with medical terminologies. Team management skills.

Keyskills :
mediclaimdoctor activitiestpahealthcare

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