Approval Specialist

Responsibilities:

• Confirm and analyze insurance patients' data against submitted documentation to avoid confusion, fraud, or claim rejection.
• Act as the primary point of contact for all insurance approval requests for both internal and external patients.
• Resolve issues related to rejected or pending approvals to ensure timely service delivery.
• Verify patient insurance policy eligibility and ensure coverage for required treatments, hospital stays, or surgical procedures to minimize the risk of rejections.
• Review all patient requests related to medical services, pharmaceuticals, diagnostics, and RMI.
• Confirm that the requested services are covered under the patient’s insurance policy.
• Prepare working papers, conduct data analysis, and compile results to support findings and inform recommendations
• Upload and maintain the “Table of Benefits” for both inpatients and outpatients in the hospital system.
• Ensure accuracy in patient deductibles, approval limits, service inclusions/exclusions, and that all contracts and policies are correctly mapped to applicable pricing.
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• Review and submit insurance approval requests promptly.
• Communicate with insurance companies to obtain approvals and actively follow up on all pending requests.
• Collaborate with insurance companies and hospital staff during emergency cases to ensure immediate patient service.
• Secure necessary approvals within the allowable time frame after patient admission.