JB-886

Job Title : Advisor, Pre-Authorization - Cantonese

Job Category Type : Healthcare

Currency : Malaysian Ringgit(MYR)

Salary : MYR 4600

Country : Malaysia

State : Kuala Lumpur

Benefits : Annual Leave;Maternity leave;Paternity leave;Medical Insurance Outpatient & Inpatient;Sick leave;Hospitalization

Job Description :

The Case Management Advisor is responsible for Pre-Authorization process from members & medical providers to ensure that medical treatments, procedures, or medications requiring prior approval from Bupa are authorized. This role is critical in streamlining the healthcare process, ensuring timely patient care, and facilitating proper reimbursement while adhering to insurance policies and regulatory guidelines

1. Review and assess pre-authorization (PA) requests from members or providers for completeness, accuracy, and eligibility in accordance with policy terms and conditions.
2. Verify medical charges against appropriate diagnosis, procedure, and medical codes to ensure consistency and compliance.
3. Communicate Pre-authorization results to members or providers within the service level agreements
4. Request additional information or clarification from members or providers to support PA decisions
5. Escalating complex or exceptional cases to senior advisors or supervisors as needed

Requirements:

1. With 1-3 years of experience in Pre-authorization or medical claims processing
2. With Healthcare background is preferred
3. With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices is preferred
4. Good time management skill and ability to multitask

WFH Allowance :

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