Team Lead Pre -Approval / Pre- Approval Officer OP & IP

Accumed; Dubai; On-site; AED 134,000 - 201,000; Full time

Job summary

A healthcare management firm seeks a Team Lead for Pre-Approval to manage claims and ensure timely approvals. Candidates should have a medical background, preferably in nursing or medicine, and should be familiar with medical coding and billing processes. Strong communication skills and proficiency in Microsoft Office are essential. The role demands high-quality work with adherence to stringent protocols, ensuring optimal patient satisfaction and minimal rejections. Ideal for those interested in a career in healthcare operations.

Qualifications

• Medical background in nursing or similar is preferred.
• Strong knowledge of medical coding is an added advantage.
• Fresher candidates may apply for junior roles.
• Fresher for junior level; willingness to relocate or work in a back-office setting.

Responsibilities

• Manage preapproval and precertification of claims.
• Monitor prior authorization for outpatient/inpatient services.
• Analyze problems and resolve issues swiftly.
• Communicate effectively with medical staff and insurers.

Skills

Medical Coding knowledge

Proficient in Microsoft Word

Proficient in Microsoft Excel

Strong background in insurance pre-authorization protocols

Education

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

Medical Billing Knowledge with certification

Job description

Job Openings Team Lead Pre -Approval / Pre- Approval Officer OP & IP

About the job Team Lead Pre -Approval / Pre- Approval Officer OP & IP

Job Family Summary:

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.

NOTE:

This role is based in our India back office which is located in Chennai. only candidates who are interested in relocating back to India should apply.

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