Precertification Officer

The Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers with high efficiency and within the agreed turnaround time to maintain the team KPIs.

What You Do

• Assess medical approval and policy use.
• Determine necessity of particular treatment plan for patient.
• Input verbal and written claims approvals regularly.
• Decide approvals per policy conditions.
• Assess high-cost claims and make decisions on high-cost and complicated cases.
• Provide clear feedback on queries from the call centre team.
• Explain declined medical claims to clients.
• Coordinate workflow and meet deadlines.
• Evaluate claims concerning eligibility.
• Meet daily Precertification productivity targets according to claims type/tenure.
• Adjudicate outpatient precertification on a fi...