Approval Officer

Job Description

Responsible for reviewing clinical documentation and assigning standardized medical codes to diagnoses, procedures, and treatments for billing, insurance claims, and maintaining accurate medical records.

Responsibilities

• Follow the mandatory SOP, checklist and relevant payer and coding guidelines.
• Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)
• Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.
• Supporting details/ justification available in EMR of all investigation done.
• Checking all CPT codes entered are correct based on CPT guidelines.
• Checking excluded ICD and CPT based on Coding guidelines.
• Approved services and rendered services are match.
• Ensuring all requested investigations are done and invoiced.
• Check the claim with correct Receiver and Payer name before finalizing the bill.
• Check the claim with correct Patient Copay application.
• Ensure all claims are submitted to insurance company.
• Check the payer’s name, rate plan and plan name selected properly.

Qualifications

• College Diploma – Any discipline or related fields. 
• Coding Certification, CPC – Certified Professional Coder (AAPC)

Proficiency in:

• ICD-10-CM (diagnosis codes)
• CPT (procedure codes)

HCPCS Level II (supplies, equipment, services)