The Insurance Administrator is responsible for facilitating all insurance pre-authorization activities including the preparation of cost estimates. •He ensures that cost estimates are accurately prepared for all services based on the CPT/CDT/UCLS/HCPCS billing rules and Mediclinic guidelines in the appropriate time required
•A relevant Diploma or Bachelors Degree – medical background is preferred
•Valid CPT Coding or Medical Coding license
•Certified coder from AAPC or AHIMA
•Code knowledge requirements are as follows:
ICD-10CM, CPT, HCPCS, CDT, DSL
•Previous Medical Insurance background preferably in a Health Care Industry or similar environment for a minimum of two years.
•Minimum 1 year experience in coding
•Above average computer literacy and a good working knowledge of Microsoft Office
•Ensures that cost estimates are accurately prepared for all services based on the CPT/CDT/UCLS/HCPCS billing rules and Mediclinic guidelines in the appropriate time required.
•Ensure all necessary supporting documentation is available to obtain timely approval
•Responsible for the review of pre-approvals and distribution to departments on a timely basis
•Responsible for the accuracy of inputs on various insurance policies and coverage details
•Responsible for the maintenance and completion of the approval log
•Ensures that all pending cases are reviewed and followed up on a daily basis
•Ensures on time coordination with external and internal clients for additional information needed for approvals
•Ensure appropriate review of bills and statements as per the Medical Necessity requirements before sending out to insurance companies to reduce risks of denial.
•Performs concurrent review of records / claims forms to verify proper documentation of principle diagnosis and secondary diagnoses including conditions qualifying as complications/co-morbidities, and major complications and co-morbidities based on the coding guidelines.
•Act as a source of information on insurance matters to patient and ensures that all patient queries on insurance matters are attended to, resolved and escalated, if required
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