Approval Officer

NMC Healthcare; Dubai; On-site; AED 120,000 - 200,000; Full time

Job summary

NMC Healthcare is seeking a professional for a role focused on medical necessity evaluations and case management. Responsibilities include coding insurance procedures, training staff on insurance protocols, and managing audit processes. Candidates should be prepared for night shifts and have strong communication skills.

Responsibilities

• Evaluate pre-approval requests based on medical necessity.
• Handle second opinion cases and case management.
• Prepare daily activity reports and manage auditing processes.

Job description

Responsibilities

• Evaluate Pre-Approval requests for medical necessity based on provided medical data and accurately code service descriptions according to accepted medical coding rules, guidelines, and policy benefits.
• Respond promptly to Insurance/TPA queries and liaise with concerned departments.
• Handle second opinion cases and case management, including evaluation and escalation.
• Perform night shift duties and work on public holidays as scheduled.
• Prepare daily activity reports for management and assist in monthly reporting.
• Manage auditing processes by preparing required documents and coordinating with coders for external audits.
• Attend meetings and presentations; train front office staff, receptionists, and nurses on insurance procedures.
• Prepare cost estimates for procedures for cash patients.
• Adjust duties in case of unplanned leaves by colleagues.
• Manage and hand over pending cases to the next shift.
• Perform any other duties assigned by the HOD within the scope of the job.