Pre-Approval Officer | Al Futtaim Health | Karama Clinic

Al Futtaim Private Company (LLC); Dubai; On-site; AED 89,000 - 134,000; Full time

Job summary

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.

Qualifications

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

Responsibilities

• 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.

Skills

Medical background

Negotiation skills

Soft skills

Job description

What you will do

• Review all claim forms which is assigned on the dashboard and provide adequate feedback on the same Update Approvals received from Insurance companies with 100 accuracyCommunicating with departments in case of any missing document or more information required
• Meet daily claims verification productivity
• Quantitative analysis Perform a comprehensive review for the record to assure the presence of all component parts such as patient and record identification signatures and dates where required and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment renderedFollows coding guidelines and legal requirements to ensure compliance with regulatory guidelinesQualitative analysis Evaluate the record for documentation consistency and adequacy Ensure that the final diagnosis accurately reflects the care and treatment rendered Review the records for compliance with established third party reimbursement agencies and special screening criteriaReceive the patient medical record on daily basis and check any deficiency in documentation if any notify the concerned staff and send it to physicianReceive the completed records and ensure that the marked deficiencies are cleared and follow the standardsTimely submissions of all preapprovals as per KPIsImprove the quality of pre-approval submission to obtain approval from the first round The role also include stop strong revenue loss strong through monitoring and coordination with all concerned stakeholders like coding team and physicians to revise IC rejections Monitor behavioural approval processes nbsp of various payors and corporates to apply customized actions to strong obtain pre-approvals strong Ensure all pre-approvals are submitted of all eligible IP OP and pharmacy to IC TPAInternal Follow up for additional information required by insurance companyInteracting with the physicians for the clinical justification of the pre approvals Ensure and work closely with the team on complex cases to obtain faster approval from payers Making sure that PAR submissions are dealt with according to Insurance industry and DHA regulations Comply with pre-approval KPI s Key Performance Indicator maintain a record of pre-approval KPIs as and when required Educate billing Approval team to enhance the process flow Ensures that targets are met within turnaround time and while maintaining quality and productivity Coordinate with CDI team to educate the physicians and other paramedical team to ensure proper claims documentations Maintain accurate monthly data of claims submissions of each insurance companyCoordination with other business stakeholders to improve overall submission process efficiency Analysis of financial data related to revenue cycle to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risk s Required skills to be successfulStrong medical background to handle reconciliation efficiently.Strong Negotiation skillsStrong soft skills