Approval Officer

NMC GROUP SERVICES.; Abu Dhabi; On-site; AED 89,000 - 134,000; Full time

Job summary

NMC GROUP SERVICES. is seeking a qualified medical professional for Insurance Claims Management and adjudication. The role requires MBBS qualification with at least two years of relevant experience in coding, claims processing, and audits.

You will handle pre-authorization evaluations, coding, reports, and audits, while liaising with departments and TPA queries. Training and shift coverage are part of duties; OSH and safety compliance is mandatory.

Qualifications

• Bachelor’s MBBS from a recognized university.
• At least 2 years of experience in Insurance Claims Management/Adjudication.
• Proficiency in Medical Coding (ICD, CPT, DRG, HCPCS).

Responsibilities

• Evaluate pre-approval requests for medical necessity based on the clinical information provided
• Accurately code service descriptions stated in prior authorization requests in accordance with accepted medical coding rules, medical guidelines, and the policy schedule of benefits
• Respond promptly to Insurance TPA queries and coordinate with the concerned departments for timely resolution
• Receive evaluate and escape second-opinion cases and case management matters as required
• Perform night shifts and public holiday duties as per the approved duty roster
• Prepare daily activity reports as required by management and assist with the preparation of monthly reports
• Handle the auditing process by arranging required documents and coordinating with coders to support external auditors
• Attend meetings and presentations as required
• Conduct training sessions for Front Office Reception and Nursing staff and keep them updated on insurance-related requirements and processes
• Prepare cost estimates for procedures for cash-paying patients
• Adjust and manage duties in the event of sudden or emergency unplanned leave of colleagues
• Manage and hand over pending cases to colleagues in the next shift to ensure continuity of work
• Perform any other duties assigned by the HOD within the scope of the job role
• Comply with all OSH and infection control policies, standards, and procedures
• Follow documented OSH procedures, instructions, and assigned responsibilities
• Maintain familiarity with emergency and evacuation procedures
• Report OSH hazards, incidents, near misses, and other safety-related issues promptly
• Assist with the preparation of risk assessments and incident reports
• Comply with waste management policies and procedures
• Attend applicable OSH and infection control training programs mock drills and awareness programs
• Ensure appropriate use of personal protective equipment (PPE) and safety systems

Skills

Medical coding proficiency

Insurance claims management

English proficiency

Education

MBBS degree

Tools

Microsoft Office

Job description

Job Responsibilities

• Evaluate pre-approval requests for medical necessity based on the clinical information provided
• Accurately code service descriptions stated in prior authorization requests in accordance with accepted medical coding rules, medical guidelines, and the policy schedule of benefits
• Respond promptly to Insurance TPA queries and coordinate with the concerned departments for timely resolution
• Receive evaluate and escape second-opinion cases and case management matters as required
• Perform night shifts and public holiday duties as per the approved duty roster
• Prepare daily activity reports as required by management and assist with the preparation of monthly reports
• Handle the auditing process by arranging required documents and coordinating with coders to support external auditors
• Attend meetings and presentations as required
• Conduct training sessions for Front Office Reception and Nursing staff and keep them updated on insurance-related requirements and processes
• Prepare cost estimates for procedures for cash-paying patients
• Adjust and manage duties in the event of sudden or emergency unplanned leave of colleagues
• Manage and hand over pending cases to colleagues in the next shift to ensure continuity of work
• Perform any other duties assigned by the HOD within the scope of the job role
• Comply with all OSH and infection control policies, standards, and procedures
• Follow documented OSH procedures, instructions, and assigned responsibilities
• Maintain familiarity with emergency and evacuation procedures
• Report OSH hazards, incidents, near misses, and other safety-related issues promptly
• Assist with the preparation of risk assessments and incident reports
• Comply with waste management policies and procedures
• Attend applicable OSH and infection control training programs mock drills and awareness programs
• Ensure appropriate use of personal protective equipment (PPE) and safety systems

Qualifications

• Bachelor’s Degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years of experience in Insurance Claims Management/Adjudication.
• Proficiency in Medical Coding, including ICD, CPT, DRG, and HCPCS.
• Excellent command of spoken and written English.
• Flexible and able to work effectively under pressure.
• Excellent knowledge of Microsoft Office applications.