Approval Officer
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Key skills for this role
About the Role
Responsible for reviewing clinical documentation, assigning medical codes, ensuring compliance, and requires coding certification and proficiency in ICD-10-CM and CPT.
Key Skills for This Role
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Overview
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.
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