Approval Officer

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 documentation is entered in the chart/EMR/claim form by the doctors.
• Supporting details/justification available in EMR of all investigations 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 matched.
• Ensuring all requested investigations are done and invoiced.
• Check the claim with correct receiver and payer name before finali...