Approval Officer
- NMC Royal Khalifa City
- Abu Dhabi - United Arab Emirates
- Full-time
وصف الوظيفة
Job Description
- Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all patients. Ensure that the details of the Pre Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
- Handling the rejected pre authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.
- Prepares reports of daily activity as requested for management and assists management in month end reporting as requested.
- Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits
- Response to Insurance/ TPA queries and liaise with concerned department.
- Responsible for receiving, evaluating and escalating second opinion cases and case management
- Perform night shift duty to sustain any issues and queries related to Authorization department
- Prepares reports of daily activity as requested for management and assists management in monthly reports as requested
- Work in all shifts as scheduled by the Head of Department.
- Strictly adheres to organization’s regulations and policies especially those related to infection control, patient safety, OSHMS, DOH, JCI and ISO.
- Supports Continuous Quality Improvement and participates and contributes to all the quality assurance activities of the service.
- Participates and contributes in scheduled in-service training programs.
- Exercises effective interpersonal skills in dealings with department staff, associates and Management.
- Maintains confidentiality as per the agreement signed.
- Demonstrates the ability to listen to others in promoting effective communication.
- Develops thorough understanding of policies and procedures of the hospital and demonstrates respect for them.
- Carries out other duties when requested by the Head of department.
- Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
- Experience in Insurance Claims management/adjudication (minimum 2 years)
- Experience in Medical Coding ICD, CPT, DRG and HCPCS.
- Excellent command of oral and written English.
- Flexible and able to work under pressure
- Excellent knowledge of Microsoft applications
