Approval Officer, NMC Hospital Deira, Dubai UAE

  • Full time
  • Dubai, UAE
  • Posted 9 months ago
  • 4000-12000 AED / Month

NMC Healthcare presently has an opening for suitably qualified candidates for the role of an Approval Officer. The successful aspirant will work at NMC Hospital located in Diera, Dubai, UAE. This job was posted by NMC on 19 October 2023 and is now vacant for all interested applicants.

Purpose of An Approval Officer

Ensures that patient treatment plans and services comply with insurance or regulatory requirements, facilitating seamless approvals and reimbursement processes.

Duties of An Approval Officer

  • Obtaining authorizations as required by insurance companies dependent upon the plan coverage for all patients.
  • Handling rejected pre authorizations between the facility and the Insurance Companies
  • 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 Insurance 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.
  • Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
  • Responsible for receiving, evaluating and escalating second opinion cases and case management.
  • Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
  • Attend Meetings and Presentation.
  • To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
  • Managing and handling pending cases (if any) to the next shift colleagues.
  • Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

Qualification & Experience

  • Bachelor’s degree in medicine or equivalent medical degree for recognized university.
  • Minimum 2 years of experience in Insurance Claims management/adjudication.

Knowledge and Skills Desired

  • Knowledge in Medical Coding ICD, CPT, DRG and HCPCS.
  • Excellent command of oral and written English.
  • Flexible and able to work under pressure and in shifts.
  •  Excellent knowledge of Microsoft applications.

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