IP Authorisation officer -G6

at  Daman

JOB DESCRIPTION

Role Purpose

• Assist Supervisor in ensuring that new guidelines, service/drug coding, updated policies and procedures that are related to duties of the coordinator are being properly implemented
• Evaluate medical necessity of requested services according to medical data provided and accurately code service descriptions/drug codes stated on prior authorisation requests based on accepted medical coding rules/guidelines and policy’s schedule of benefits
• Ensure that proper documentation of the data including business decisions are correctly done on the system with focus on accuracy, efficiency and quality
• Constantly work on improving the TAT and relevant functional and personal competencies
• Handle authorisation related issues/queries of health care providers or customers and providing them with appropriate assistance and guidance
• Assist Supervisor in training new staff as per their function
• Report suspected cases of fraud/abuse by healthcare providers to respective Supervisor
• Evaluate and sign high cost authorisation letters from Medical Authorisation Coordinator as per his authority
• Initiate the resolving of complex situations and issues at the coordinator level and take measures to avoid the reoccurrence of similar incidents
• Handle changes in the workload flow from healthcare providers in terms of time, quantity and type of prior authorisation requests received with clear focus on quality and set target
• Escalate cases needing Case Management intervention based on communicated criteria
• Perform shift duty to ensure 24/7 operations of the department

Key Requirements and Qualifications

• Minimum 3 years in any of the medical units of a health insurance company or third-party administrator (TPA), out of which minimum 1 year as Medical Authorisation Coordinator IP
• Experience in customer service handling customer queries and grievances is a plus
• Certification of the medical coding systems is a plus
• Bachelor’s degree in Nursing, Pharmacy or another paramedical field

Skills and Competencies

• Good command of written/spoken English; knowledge of Arabic language is an advantage
• Basic analytical, execution, problem solving and decision-making skills
• Good level of customer service orientation and professionalism in all interactions
• Basic knowledge of health insurance concepts

Job ID 300000277423394

• Assist Supervisor in ensuring that new guidelines, service/drug coding, updated policies and procedures that are related to duties of the coordinator are being properly implemented
• Evaluate medical necessity of requested services according to medical data provided and accurately code service descriptions/drug codes stated on prior authorisation requests based on accepted medical coding rules/guidelines and policy’s schedule of benefits
• Ensure that proper documentation of the data including business decisions are correctly done on the system with focus on accuracy, efficiency and quality
• Constantly work on improving the TAT and relevant functional and personal competencies
• Handle authorisation related issues/queries of health care providers or customers and providing them with appropriate assistance and guidance
• Assist Supervisor in training new staff as per their function
• Report suspected cases of fraud/abuse by healthcare providers to respective Supervisor
• Evaluate and sign high cost authorisation letters from Medical Authorisation Coordinator as per his authority
• Initiate the resolving of complex situations and issues at the coordinator level and take measures to avoid the reoccurrence of similar incidents
• Handle changes in the workload flow from healthcare providers in terms of time, quantity and type of prior authorisation requests received with clear focus on quality and set target
• Escalate cases needing Case Management intervention based on communicated criteria
• Perform shift duty to ensure 24/7 operations of the departmen