Medical Liaison Coordinator - Preapprovals and claims

at  Adecco

MEDICAL LIAISON COORDINATOR - PREAPPROVALS AND CLAIMS

We are currently recruiting top talent for the role of Medical Liaison Coordinator - Preapprovals and claims for our client, a leading Insurance company in Dubai.
1 year contract - renewable
MBBS is mandatory
UAE Experience is mandatory
Job Purpose:
Liaising and servicing HealthCare Providers/insured members by ensuring a smooth Medical Preauthorisation process.

Description:

• Responsible for reviewing, analysing & authorising services in line with benefits adjudication as per medical and coding guidelines. This includes diagnosis, prescription of medicine, minor operations, inpatient hospital confinement, outpatient surgeries, outpatient laboratory tests, physiotherapy, MRI/ CT scan tests and different treatments for injuries, diseases and other ailments. Authorizing Medical / Surgical Outpatient, Inpatient Cases for insured members by Network Hospitals & Clinics. This include validation of all applicable inpatient and daycase DRG
• Identifying cases for Case Management of insured members who are confined to a hospital for medical/ surgical management and sending Case Alerts to the Case Management Unit
• Coordinating with insured members & discussing the treatment plan recommended by treating physicians, as well as initiating, if required, the Second Medical Opinion Process
• Providing 24/7 Preapprovals Call Support service to insured members
• Preparing Savings Report & working towards the Target set by Line Manager
• Communicating with the Providers/insured through emails/telephone regarding preapprovals.
• Providing support to Providers & Insured on the Pharmacy Management (Program PBM)
• Issuing ‘Guarantee of Payment’ letters to non-contracted Providers upon approval by the Line Manager
• Contributing to the on-going ‘Fraud & Abuse Capture’ process and apprising FWA team
• Ensuring that the preauthorisation requests are attended and reverted to within the Stipulated Turnaround Time
• Ensuring that call abandonment rate does not exceed the target set by Line Manager.
• Understand and adhere to all Compliance requirements, including but not limited to, reporting of suspicious transactions, screening requirements, as applicable, and the retention of Company records; plus provide timely support and unrestricted access to information as well as attend all training requests from Compliance.

Please refer the Job description for details