JB-887
Job Title : Senior Advisor, Pre-Authorization - Cantonese
Job Category Type : Healthcare
Currency : Malaysian Ringgit(MYR)
Salary : MYR 5500
Country : Malaysia
State : Kuala Lumpur
Benefits : Annual Leave;Maternity leave;Paternity leave;Medical Insurance Outpatient & Inpatient;Sick leave;Hospitalization
Job Description :
The Case Management Senior Advisor is responsible for complex Pre-Authorization process mainly for day case & hospital cases and provide guidance to junior advisors and new joiners to ensure high standards of accuracy and efficiency in Pre-authorization process. This role also need to focus on the high charges cases and N&C will be applied if necessary.
- Review and process complex pre-authorization cases, particularly for day-case and hospital cases, ensuring alignment with policy guidelines and service standards.
- Mentor a team of Pre-Authorization Advisors, providing technical guidance, coaching, and support on challenging cases to ensure consistent decision-making.
- Review and validate pre-authorization decisions made by junior team members, ensuring compliance with internal guidelines and quality benchmarks.
- Collaborate with service providers and internal teams, including Provider Relations, to resolve inquiries and ensure smooth coordination of hospitalization and surgical services.
- Maintain accurate and up-to day documentation in the Claims Management System, supporting audit readiness and data integrity
Requirements:
- With 3-5 years of experience in Pre-authorization or medical claims processing
- With Healthcare background is preferred
- With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices is preferred
- Good time management skill and ability to multitask
- Good knowledge in Claims Management System
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