Approval Officer

About this opportunity

1. Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details of the Pre Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.

2. Handling the rejected pre authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval. 

3. Prepares reports of daily activity as requested for management and assists management in month end reporting as requested. 

Responsibilities

• Evaluates pre-approval requests for medical necessity based on the medical information provided and accurately codes service descriptions in accordance with accepted medical coding rules, medical guidelines, and the policy schedule of benefits.

• Responds to Insurance/TPA queries and liaises with the concerned departments without delay.

• Receives, evaluates, and escalates second-opinion cases and case management requests.

• Performs night shifts and public holiday duties as per the assigned duty roster.

• Prepares daily activity reports as requested by management and assists in preparing monthly reports.

• Handles the auditing process, arranges required documents and records, and coordinates with coders to assist external auditors.

• Attends meetings and presentations as required.

• Trains Front Office staff, Receptionists, and Nurses and keeps them updated on insurance-related information.

• Prepares cost estimates for procedures for cash-paying patients.

• Adjusts duties in case of sudden or emergency unplanned leave by colleagues.

• Manages and hands over pending cases, if any, to colleagues on the next shift.

• Performs any other jobs or duties assigned by the HOD from time to time within the scope of the job title.

• Complies with all OSH and infection control policies, standards, and procedures and cooperates with hospital management to meet these requirements.

• Works in accordance with documented OSH procedures and instructions and fulfils specific assigned responsibilities.

• Maintains familiarity with emergency and evacuation procedures.

• Reports OSH hazards, incidents, near misses, and issues and assists with the preparation of risk assessments and incident reports.

• Complies with waste management procedures and policies.

• Attends applicable OSH and infection control training programs, mock drills, and awareness programs.

• Uses appropriate personal protective equipment and safety systems.

Qualifications

• Bachelor’s Degree in Medicine (MBBS) from a recognized university.

• Minimum 2 years of experience in Insurance Claims Management/Adjudication.

• Experience in medical coding, including ICD, CPT, DRG, and HCPCS.

• Excellent command of oral and written English.

• Flexible and able to work effectively under pressure.

Imported source listing. Details are supplied by the source and have not been independently verified by WorkerEra. Confirm the current vacancy on the employer’s page.

Source: NMC Healthcare — United Arab Emirates — Administration