Pre-Approval & Claims Compliance Specialist

Al Futtaim Private Company (LLC); Dubai; Vor Ort; AED 89.000 - 134.000; Vollzeit

Zusammenfassung

Al Futtaim Private Company (LLC) seeks a claims pre-approval coordinator to review and feedback on claim forms, ensuring accuracy and compliance with coding guidelines and regulatory requirements. You will liaise with physicians and departments to obtain missing information and accelerate approvals.

The role focuses on documenting, validating pre-approvals for IP, OP and pharmacy, and monitoring KPIs to reduce revenue loss through proactive collaboration with CDI teams and payers.

Qualifikationen

• Strong medical background to handle reconciliation efficiently.
• Strong negotiation skills.
• Strong soft skills.

Aufgaben

• Review all claim forms assigned on the dashboard and provide feedback with high accuracy.
• Update approvals received from Insurance companies with attention to missing documents or further information required.
• Meet daily claims verification productivity targets and ensure timely processing.
• Perform quantitative analysis to ensure presence of patient and record identifiers and dates where required.
• Follow coding guidelines and regulatory requirements for compliance.
• Evaluate records for documentation consistency and adequacy and ensure final diagnosis reflects care provided.

Kenntnisse

Medical background

Negotiation skills

Soft skills

Jobbeschreibung

Al Futtaim Private Company (LLC) seeks a claims pre-approval coordinator to review and feedback on claim forms, ensuring accuracy and compliance with coding guidelines and regulatory requirements. You will liaise with physicians and departments to obtain missing information and accelerate approvals.

The role focuses on documenting, validating pre-approvals for IP, OP and pharmacy, and monitoring KPIs to reduce revenue loss through proactive collaboration with CDI teams and payers.