Pre-Approval Officer - IP

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

Job summary

A healthcare management firm is seeking an Associate Pre-Approval to manage claims preapproval and precertification processes. The candidate will work closely with nurses and physicians to address any denied cases, ensuring high-quality submissions to insurance payers. A medical background in Nursing or related fields is preferred, along with knowledge of medical coding and billing. Proficiency in Microsoft Word and Excel is essential. This role requires excellent communication skills and timely resolution of issues.

Qualifications

• Preferred medical background for the position.
• Knowledge of medical coding is a plus.
• Certification in medical billing is advantageous.

Responsibilities

• Responsible for preapproval and precertification of claims.
• Monitor and follow up on prior authorization.
• Contact payers and physicians for approval-related matters.

Skills

Medical Coding knowledge

Proficient in Microsoft Word

Proficient in Microsoft Excel

Knowledge of insurance pre-authorization protocols

Education

Medical Background - Nursing/BAMS/BHMS/MBBS/BDS

Job description

The Operations Department is responsible to manage all aspects of claims management including Onsite operations and back end processing. The department primarily works on main objective of submitting the claims in time with highest quality to ensure the client receives the payment with minimal or no rejections.

Role Summary

Preapproval Department is based at the hospital site which manages precertification for all IPD and OPD cases for insured members contracted with the hospital as per designated networks.

Major role is at seeking preapproval for services with patient satisfaction-oriented duties.

The Associate Pre-Approval is responsible for registration and length of stay (LOS) assignment for all acute care hospitals admissions. Reviews and Discusses with nurses and physicians on denied cases or pending cases. Submits all requests, including required forms and limited documentation when requested, via DHPO/ websites. Notifies Hospitals by written notification of approval, rejection and denial of requests. Applies judgement in reconsideration for appeal of rejected cases.

Primary Responsibilities

• Preapproval and Precertification for claims requiring approval.
• Making Cost estimates according to procedures
• Monitoring and follow up on prior authorization for outpatient/inpatient services
• Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer
• Contacting the payers/TPA for approval related matters. Communicates adequately with external parties.
• Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.
• Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution
• Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate
• Timely and meets deadlines.
• Reporting trends related to preapproval to reporting TL /Supervisor

Job Requirements

• Medical Background - Nursing /BAMS/BHMS/MBBS/BDS preferred.
• Medical Coding knowledge preferred. Certification will be added advantage
• Fresher for Junior Level post,
• Medical Billing Knowledge with certification will be as well an added advantage.
• Proficient in the software modules. (Microsoft Word and Excel)
• Strong background of various insurance pre-authorization protocols and portals

Key Performance Indicators (KPI's)

• Completing the assigned/allocated preapproval claims as per TL/Supervisor >95% quality (error free) to be achieved on given tasks.
• Strict Adherence to process and protocols of payers and as well organization
• Maintain TAT for all approval within 24 to 48 hours