Authorization Specialist Mubadala Health UAE
Full time @Mubadala Health posted 11 months ago in Healthcare Shortlist Email JobJob Detail
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Job ID 6518
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Career Level Senior
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Experience 2 Years
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Gender Male Female
Job Description
Mubadala Health is presently looking for suitably qualified & experienced candidate for the job role of an Authorization Specialist. The aspiring candidate will work at Healthpoint (a subsidiary of Mubadala Health) located in Abu Dhabi. This job has recently been posted by Mubadala Health & is now open for all desirous applicants, fulfilling the under mentioned criteria !
Job Purpose of An Authorization Specialist
The Authorization Specialist must 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 prior authorization requests.
Job Duties of An Authorization Specialist
- 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.
- Responsible to prepare the quotation in liaising with the clinical team and technicians for the required department and securing the approval within the KPI TAT.
- Manage correspondence with insurance companies, clinicians and patients as required.
- Document all prior authorization information including approval dates, prior authorization number in hospital system.
- Stay informed and research information regarding insurance criteria changes/updates for prior authorization.
- Respond to Insurance / TPA on queries / rejections and coordinating with concerned department for additional documents / justifications.
- Provide daily and monthly reports as requested to track pre-authorization performance.
- Managing and handling the authorization TAT within the defined department KPI.
- If assigned to handle the claim audit, submit the claims to Shafafiya on a timely manner and respond to rejected claims for appropriate reimbursement.
- Communicate with payers on the authorization/claim level rejections and clarifications to enhance the claim quality.
- Ensure patients’ demographics and medical information are secure and comply with MH compliance and regulations.
- Report incidents, including near misses, to promote a learning culture within the organization.
- Adhere to recommended infection control practices to prevent health risks to colleagues, patients, families, and visitors.
- Remain flexible as MH is a dynamic organization, open to changes in service provision.
- Ensure staff compliance with organizational policies, processes, and procedures.
What You’ll Do More?
- Adheres to the division’s policies, procedures and standards while ensuring compliance with applicable regulatory bodies.
- Contributes towards an innovative culture of continuous improvement for enhancing operational efficiency and effectiveness.
- Participates in meetings and maintains professionalism and confidentiality as per the organization’s standard code of conduct.
- Completes personal performance evaluation cycle in a timely manner.
Who Can Apply?
Qualification
- Bachelor Degree from a recognized university.
Experience
- Minimum 2 years experience in prosthetics and orthotics approval and adjudication.
- Minimum 2 years experience in Insurance Claims management / rejection.
- Experience in Medical Coding ICD, CPT, DRG and HCPCS.
Certification
- AAPC or AHIMA Certified Medical Coder with sound knowledge in Prosthetics and Orthotics coding.
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