Officer, Authorisation

Job Description

To support the authorization process by evaluating requests, ensuring compliance with medical policies, and coordinating with internal and external stakeholders. This role contributes to efficient operations, timely approvals, and adherence to healthcare regulations.

Responsibilities

Core Responsibilities:
•    Obtain and verify medical information required for authorization approvals.
•    Evaluate authorization requests based on established medical policies and insurance guidelines.
•    Assist in processing authorization approvals and denials in a timely manner.
•    Communicate with healthcare providers to clarify documentation and policy compliance.
•    Draft reports on authorization trends, key metrics, and performance indicators.
•    Support the resolution of authorization-related queries from internal and external stakeholders.
•    Conduct preliminary assessments of requests and escalate complex cases when necessary.
•    Interpret medical reports and insurance policies to determine coverage eligibility.
•    Document authorization decisions and maintain accurate case records in the system.
•    Identify potential issues in claims and authorization requests and report them for further review.
•    Summarize case findings and present them to senior team members for decision-making.
•    Notify relevant departments about changes in authorization procedures or policies.
 

Quality & Excellence Management:
•    Observe adherence to authorization policies and ensure compliance with regulatory standards.
•    Participate in internal audits and quality assurance initiatives.
•    Support initiatives to enhance customer satisfaction through efficient authorization processes.
•    Report discrepancies or inconsistencies in authorization records to management.
•    Assist in maintaining authorization process documentation for continuous improvement.
 

Qualifications

Preferred Educational Qualifications and Professional Certifications
•    Bachelor’s Degree in Healthcare Management, Insurance, Business Administration, or a related field.
•    Master’s Degree in Healthcare Management, Health Economics, Business Administration, or a related field is preferred. 
•    Professional certifications in Health Insurance, Medical Coding, Healthcare Compliance, or equivalent are advantageous.

Experience    
•    A minimum of 0-2 years of experience in health insurance authorization, claims processing, or a related healthcare support function.