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Approval Officer at NMC Specialty AUH

Abu Dhabi, Abu Dhabi Emirate, United Arab Emirates -

Full Time

Start Date

Immediate

Expiry Date

22 Jul, 26

Salary

0.0

Posted On

23 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Coding, ICD, CPT, DRG, HCPCS, Insurance Claims Management, Case Management, Medical Necessity Evaluation, Pre-authorization, Claim Adjudication, Microsoft Applications, Communication, Interpersonal Skills, Reporting, Patient Safety, Infection Control

Industry

Hospitals and Health Care

Description

1. Evaluate the pre-authorization 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 2. Response to Insurance/ TPA queries and liaise with concerned department. 3. Responsible for receiving, evaluating and escalating second opinion cases and case management. 4. Perform night shift duty to sustain any issues and queries related to Authorization department. 5. Prepares reports of daily activity as requested for management and assists management in monthly reports as requested. 6. GENERAL RESPONSIBILITIES: 1. Work in all shifts as scheduled by the Head of Department. 1. Strictly adheres to organization’s regulations and policies especially those related to infection control, patient safety, OSHMS, DOH, JCI and ISO. 2. Supports Continuous Quality Improvement and participates and contributes to all the quality assurance activities of the service. 1. Participates and contributes in scheduled in-service training programs. 2. Exercises effective interpersonal skills in dealings with department staff, associates and Management. 3. Maintains confidentiality as per the agreement signed. 1. Demonstrates the ability to listen to others in promoting effective communication. 2. Develops thorough understanding of policies and procedures of the hospital and demonstrates respect for them. 4. Carries out other duties when requested by the Head of department.

Responsibilities

The Approval Officer evaluates pre-authorization requests for medical necessity and ensures compliance with insurance guidelines and coding standards. They also manage insurance queries, handle rejected claims, and prepare daily activity reports for management.