<ul><li>Dealing with patients health care related documents.</li><li>Ensuring error free processing of pre authorisation within agreed TAT (Turnaround time).</li><li>Entering accurate information into the application defined by the organization.</li><li>Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures defined by the insurer and the organization.</li><li>Inform providers as needed and file completed pre certification requests as per procedures.</li><li>Any authorization not as per the limit or as per the process to be escalated to the team manager on priority.</li><li>Any medical opinion required from the specialist to be escalated to the specialist.</li><li>Ensuring process compliance is met as per regulatory procedures.</li><li>Maintaining Daily excel maintenance for Pre auth cases received and processed.</li></ul>

Medical Officer