Authorization Specialist

SUNDUS MANAGEMENT CONSULTANCY & STUDIES BUREAUL.L.C; Abu Dhabi; On-site; AED 70,000 - 100,000; Full time

Job summary

Sundus Management Consultancy & Studies Bureau L.L.C in Abu Dhabi is seeking an experienced Insurance Verification and Authorization Specialist to ensure accurate preauthorizations, eligibility checks and timely referrals. The role demands meticulous attention to medical codes and payer requirements within a fast-paced healthcare setting.

You will collaborate with clinicians, billing staff and external providers, manage EHR workflows, resolve denials with the team, and support quality standards

Qualifications

• High School Diploma or GED required.
• Minimum of 5-7 years of direct experience in healthcare insurance verification and authorization.
• Proficiency in utilizing Electronic Health Record (EHR) and practice management software.
• Strong understanding of medical terminology, CPT, HCPCS, and ICD-10 coding principles.

Responsibilities

• Interpret insurance plans, SOB exclusions, and network eligibility.
• Process referrals and authorization requests accurately and promptly.
• Review medical records, patient history, diagnoses, and treatment plans for coding accuracy.
• Communicate effectively with patients, insurers, physicians, clinical teams, and external facilities.
• Monitor EMR referral queues, follow Lean workflows, and minimize delays in patient care.
• Coordinate with Financial Counselors on denials and retro-authorizations where appropriate.

Skills

EHR proficiency

Authorization processing

Medical terminology

Education

Associate's or Bachelor's degree in healthcare administration

Tools

Practice management software

EHR systems

Job description

Insurance Benefits & Eligibility

Interpret insurance plans Summary of Benefits SOB exclusions insurance cards network eligibility patient financial responsibility and preauthorization requirements

Referral & Preauthorization Management

Process referrals and authorization requests accurately and promptly utilizing insurance portals and following payer-specific requirements.

Medical Records Coding

Review medical records patient history diagnoses and treatment plans ensure appropriate ICD-10 CPT HCPCS CDT codes and medical necessity documentation.

Communication & Coordination

Communicate effectively with patients insurance payers physicians clinical teams and external healthcare facilities to obtain required information and provide authorization updates.

Workflow & Timely Processing

Monitor EMR referral queues follow established Lean workflows resolve pending requests within acceptable timeframes and minimize delays in patient care.

Denial Management Compliance

Coordinate with Financial Counselors on denied requests manage retro-authorizations where appropriate escort payer-related trends and comply with DOH adjudication rules and departmental quality standards.

Performance & Teamwork

Meet clients core competencies departmental KPIs and productivity goals educate clinicians on authorization requirements demonstrate teamwork and perform other assigned duties.

Qualifications

High School Diploma or GED required; Associate's or Bachelor's degree in healthcare administration or a related field preferred.

Minimum of 5-7 years of direct experience in healthcare insurance verification and authorization. Proficiency in utilizing Electronic Health Record (EHR) and practice management software. Strong understanding of medical terminology, CPT, HCPCS, and ICD-10 coding principles.