Night-Shift Approval & Claims Coding Specialist

NMC healthcare LLC; United Arab Emirates; On-site; AED 200,880 - 312,480; Full time

Job summary

NMC Healthcare LLC is seeking a qualified professional to manage insurance claims and pre-approvals. The role involves coding, responding to insurer queries, and coordinating with various departments to ensure efficient case management.

Candidates should have MBBS, at least 2 years in claims management, and strong medical coding skills (ICD, CPT, DRG, HCPCS). Proficiency in English and MS Office is essential.

Qualifications

• Bachelor Degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years in insurance claims management/adjudication.
• Experience in medical coding ICD, CPT, DRG, and HCPCS.
• Excellent command of oral and written English.
• Flexible and able to work under pressure.
• Proficient in Microsoft applications.

Responsibilities

• Evaluate Pre-Approval requests from medical necessity, accurately coding the service description codes stated on 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 departments without delay.
• Receive, evaluate, and escalating second opinion cases and case management.
• Perform night shift duty and on public holidays as per duty roster.
• Prepare daily activity reports for management and assist in monthly reports as requested.
• Handle auditing process by arranging required documents and checking with coders to 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 in case of any sudden/emergency unplanned leaves by colleagues.
• Manage and handle pending cases, if any, to the next shift colleagues.
• Perform any other jobs or duties assigned by the HOD within the scope of job title.

Skills

English fluency

Pressure handling

MS Office

Education

MBBS

Tools

Medical coding ICD CPT DRG HCPCS

MS Office

Job description

NMC Healthcare LLC is seeking a qualified professional to manage insurance claims and pre-approvals. The role involves coding, responding to insurer queries, and coordinating with various departments to ensure efficient case management.

Candidates should have MBBS, at least 2 years in claims management, and strong medical coding skills (ICD, CPT, DRG, HCPCS). Proficiency in English and MS Office is essential.