Pre-Authorization Specialist: Payer Liaison

Sheikh Shakhbout Medical City; Abu Dhabi; On-site; AED 180,000 - 260,000; Full time

Job summary

Sheikh Shakhbout Medical City is seeking a Specialist-Authorization to initiate Pre-Authorization requests and coordinate with payers, physicians, and clinical staff. This role ensures medical necessity, collects supporting information, and tracks pre-certifications for procedures ordered by physicians.

The ideal candidate has extensive revenue cycle experience, healthcare certifications, and strong knowledge of payer requirements.

Qualifications

• 12 years of Revenue Cycle Experience in lieu of degree.
• Healthcare Certification (CRCR and/or CHAM).
• Extensive knowledge of healthcare revenue cycle systems.
• Minimum two years of medical insurance verification and authorization.
• Billing and coding experience preferred.
• Experience with complex coding, insurance issues, pre-certification, and outbound referral management.
• Experience with CPT, ICD-10, HCPCS, LMRPs and related guidelines.
• Experience with third-party payer requirements, contracts, authorization and payment practices.
• Understanding of insurance requirements for prior authorization.
• Knowledge of registration, verification, pre-certification and scheduling procedures.
• Knowledge of payer processes (website, fax, contact number) for submitting documentation.
• Proficient knowledge of Microsoft Office and Outlook.
• Proficient knowledge of Medical Terminology and Medical Coding.
• Understanding of insurance billing procedures and practices.
• 1–3 years of prior authorization experience in large healthcare networks.
• Knowledge of ICD-10 and CPT-4.
• Experience with insurance terminology.

Responsibilities

• Initiate Pre-Authorization requests to payers for procedures ordered by physicians.
• Collect clinical information and coordinate with Case Management and Utilization Review as needed.
• Communicate requirements to service line partners and reschedule when authorization is pending.
• Contact payers by phone, fax or portal to obtain benefits and authorization details.
• Ensure all authorizations, pre-certifications and financial obligations are documented clearly.
• Monitor and respond to inquiries via email, fax and phone within defined timeframes.
• Stay informed on insurance criteria for prior authorization and assist patients and physicians as needed.

Skills

Revenue cycle experience

Payer authorization

Insurance verification

Medical coding CPT ICD-10

Microsoft Office

Payer communications

CRCR/CHAM certification

Education

12 years revenue cycle experience in lieu of degree

Tools

Microsoft Office

Outlook

Job description

Sheikh Shakhbout Medical City is seeking a Specialist-Authorization to initiate Pre-Authorization requests and coordinate with payers, physicians, and clinical staff. This role ensures medical necessity, collects supporting information, and tracks pre-certifications for procedures ordered by physicians.

The ideal candidate has extensive revenue cycle experience, healthcare certifications, and strong knowledge of payer requirements.