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Approval Officer at ROYAL MEICAL CENTRE

Al Ain, Abu Dhabi Emirate, United Arab Emirates -

Full Time

Start Date

Immediate

Expiry Date

14 Jun, 26

Salary

0.0

Posted On

16 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Necessity Evaluation, Medical Coding, Prior Authorization, Insurance Claims Adjudication, ICD, CPT, DRG, HCPCS, Liaison, Case Management, Reporting, Auditing Process, Training, Cost Estimation, Flexibility, Microsoft Applications

Industry

Hospitals and Health Care

Description

DUTIES AND RESPONSIBILITIES : 1. 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 2. Respond to Insurance/ TPA queries and liaise with concerned department without ny delay. 3. Responsible for receiving, evaluating and escalating second opinion cases and case management 4. Perform night shift duty and on public holidays as per duty roster. 5. Prepares reports of daily activity as requested for management and assists management in monthly reports as requested. 6. Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors 7. Attend Meetings and Presentation 8. Train Front office, Receptionist and Nurses and keep them updated about Insurance details. 9. Prepare cost estimate for procedures for Cash Patient 10. To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues. 11. Managing and handling pending cases (if any) to the next shift colleagues. 12. Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title

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Responsibilities

The Approval Officer evaluates pre-approval requests based on medical necessity and coding rules, responds to insurance queries, and manages second opinion cases and case management responsibilities. This role also involves performing night shifts, preparing activity reports for management, and handling the external auditing process.