19 Apr 2024

Job details

226902 - Medical Insurance Coverage Pre-authorization Specialist

Assess the applicability and necessity of the proposed medical care and treatments; provide authorization (approval) for the medical procedures on behalf of the insurance companies; and provide advise on possible policy changes to monitor health care costs.

Main Tasks:
  • Coordinate with the medical specialists to understand patients' health condition; and determine the applicability and need for the proposed medical care and treatments.
  • Review the terms of the insurance policy to determine the size of medical care coverage; and proposed the medical treatments.
  • Approve of or reject the proposed medical treatments and care, based on the medical opinion and insurance policy coverage.
  • Work on adjusting health care costs by detecting duplications, unnecessary treatments or wasting of treatments; and recommend improvements and possible policy changes.
  • Prepare the reports of pre-authorization, reports on authorization period; and document and keep the transactions.

Educational Level:
  • Bachelor degree

Educational Field:
  • Medical diagnostic and treatment technology

Skills:
  • Team Work
  • Ability to build relationships
  • Analytical Thinking
  • Effective Communication
  • Focus on Servie Quality

Technical skills:
  • Medical terminology
  • Medical documentation
  • Claims adjustment (sickness and accident insurance)
  • Pharmacy

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