Approval Officer

NMC healthcare LLC; Abu Dhabi; On-site; AED 223,200 - 334,800; Full time

Job summary

NMC healthcare LLC, located in Abu Dhabi, requires an experienced professional for the role involving Insurance Claims management. Key responsibilities include reviewing pre-authorization requests, evaluating medical necessity, and managing claims processing in compliance with insurance regulations.

Applicants should hold a Bachelor's Degree in Medicine (MBBS) and possess at least 2 years of experience in insurance claims management. Strong English communication skills and proficiency in medical coding are essential. Join a dynamic team and contribute to healthcare excellence.

Qualifications

• Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
• Experience in Insurance Claims management/adjudication (minimum 2 years).
• Experience in Medical Coding ICD, CPT, DRG and HCPCS.
• Excellent command of oral and written English.

Responsibilities

• Apply medical knowledge and best insurance practices.
• Handle rejected pre-authorization and get required justification.
• Prepare reports of daily activity for management.
• Evaluate Pre-Approval requests for medical necessity.
• Respond to Insurance TPA queries.
• Perform night shift duty and on public holidays.
• Handle Auditing Process and assist external Auditors.
• Train Front office Receptionist and Nurses.

Skills

Insurance Claims management

Medical Coding

Microsoft applications

Communication in English

Flexibility under pressure

Education

Bachelor Degree in Medicine (MBBS)

Job description

Responsibilities

• 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, and ensure that the details of the Pre‑Authorization Requests are in line with regulators standards especially the claim adjudication Rules and Business Rules.
• Handle the rejected pre‑authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.
• Prepare reports of daily activity as requested for management and assist management in month end reporting.
• Evaluate the Pre‑Approval requests for medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests according to accepted medical coding rules, medical guidelines and policy schedule of benefits.
• Respond to Insurance TPA queries and liaise with concerned department without any delay.
• Receive, evaluate and escalating second opinion cases and case management.
• Perform night shift duty and on public holidays as per duty roster.
• Handle Auditing Process, arrange required documents and papers and check with coders to assist external Auditors.
• Attend meetings and presentations.
• Train Front office Receptionist and Nurses and keep them updated about Insurance details.
• Prepare cost estimate for procedures for Cash Patient.
• Adjust duties in case of any sudden emergency unplanned leaves by colleagues.
• Manage and handle pending cases to the next shift colleagues.
• Perform any other jobs or duties assigned by the HOD from time to time within the scope of job title.
• Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements.
• Work according to documented OSH procedures and instructions and specific responsibilities.
• Be familiar with emergency and evacuation procedures.
• Notify OSH Hazards, incidents, near misses and issues and assist with the preparation of risk assessments and incident reports.
• Comply with waste management procedures and policies.
• Attend applicable OSH infection control training programs, mock drills and awareness programs.
• Use appropriate personal protective equipment and safety systems.

Qualifications

• Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
• Experience in Insurance Claims management/adjudication (minimum 2 years).
• Experience in Medical Coding ICD, CPT, DRG and HCPCS.
• Excellent command of oral and written English.
• Flexible and able to work under pressure.
• Excellent knowledge of Microsoft applications.