Approval Officer

NMC Healthcare; Al Ain; On-site; AED 180,000 - 300,000; Full time

Job summary

NMC Healthcare in the United Arab Emirates is seeking a knowledgeable professional to manage medical insurance claims, pre-authorization coding, and case management. You will liaise with insurance providers, train staff on insurance procedures, and prepare cost estimates for cash patients.

The role requires MBBS, 2+ years in claims/adjudication, and strong English communication. You will work with a team across departments and may include shifts as needed.

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

Responsibilities

• Evaluate pre-approval requests for medical necessity and code service descriptions accordingly.
• Respond to Insurance/TPA queries and liaise with concerned departments promptly.
• Manage second opinion cases and overall case management.
• Perform night shift and on public holidays as required.
• Prepare daily activity reports and assist monthly management reports.
• Handle auditing processes; arrange documents and assist external auditors.
• Attend meetings and presentations.
• Train front office, receptionists, and nurses on insurance details.
• Prepare cost estimates for procedures for cash patients.
• Adjust duties for sudden or unplanned leaves by colleagues.
• Manage pending cases and hand over to next shifts.
• Perform any other duties assigned by the HOD within scope.

Skills

Medical coding

Insurance claims

Communication skills

MS Office

Work under pressure

Education

MBBS (Bachelor Degree in Medicine)

Tools

Microsoft Office

Job description

Job Description:

Responsibilities

1. Evaluate the Pre Approval requests from 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’s schedule of benefits
2. Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
3. Responsible for receiving, evaluating and escalating second opinion cases and case management
4. Perform night shift duty and on public holidays as per duty roster.
5. Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
6. Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors
7. Attend Meetings and Presentation
8. Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
9. Prepare cost estimate for procedures for Cash Patient
10. To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
11. Managing and handling pending cases (if any) to the next shift colleagues.
12. Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title

Qualifications

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

Requirements: