Pre-authorization Administrator at Career Site

Doha, , Qatar -

Full Time

Start Date

Immediate

Expiry Date

13 Jun, 26

Salary

0.0

Posted On

15 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Eligibility Verification, Prior Authorization, Coordination Of Benefits, Health Insurance Companies Communication, Medical Necessity Documentation, Payer Updates Knowledge, Stakeholder Communication, Rejection Follow-up, Issue Escalation, System Updates, Record Keeping, Confidentiality Maintenance, Time Management, Medical Terminology Understanding, Customer Service, Microsoft Office Suite Proficiency

Industry

Hospitals and Health Care

Description

JOB SUMMARY: The Pre-authorization Administrator is a member of the Patient Financial Services Department. This position is responsible for reviewing and validating insurance eligibility, and coordination of prior authorization pre-certifications, authorization, coordination of benefits, and ongoing communications with insurance companies. KEY ROLE ACCOUNTABILITIES: * Verifies accurate patient demographics & healthplan, confirms eligibility verification and member benefit coverage. * Contacts health insurance Company to determine appropriate prior authorization process. Works closely with clinical teams to obtain and clarify documentation to demonstrate medical necessity when deemed necessary. * Maintains a high level of understanding of health insurance companies, provider guidelines, and payer updates. * Responsible for insurance verifications and accurate communications to various stakeholders regarding the insurance coverage. * Follows up on and assists in rejections from health insurance companies and take any necessary follow up action. * Serves as a liaison between health insurance companies, staff and patients to resolve any concerns and maintain a positive working relationship. * Performs urgent requests in a timely manner and escalates issues to Line Manager as deemed necessary. * Updates the system with any actions, comments or issues that is related to pre-authorization (conversations approvals, partial approval, denials or request of additional information, etc.) * Maintains proper logs and documentation on assigned requests. * Covers on-call shifts as per set monthly schedule and compliant with hospital policies and procedures. * Participates in department meetings and departmental process improvement activities. * Maintains confidentiality of all patients and medical/clinical information. * Maintains working documents in accordance with internal record keeping standards. * Maintains confidentiality at all times. * Maintains a professional demeanor and upholds the organizational values at all times. * Follows all Hospital related policies and procedures. * Participates in professional development activities when applicable. * Performs other related duties as assigned. * Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies * Adheres to and promotes Sidra’s Values QUALIFICATIONS, EXPERIENCE AND SKILLS: ESSENTIAL PREFERRED Education Bachelor’s Degree in Business, Commerce or other related field Formal revenue cycle, health insurance and/or patient billing training Experience 2+ years’ experience in a related role in a healthcare facility or health insurance company Experience in a large healthcare facility Certification and Licensure Professional Membership Job Specific Skills and Abilities * Demonstrated organizational and time management skills * Demonstrated knowledge of medical insurance and coverage * Demonstrated ability to understand medical terminology * Demonstrated ability to be flexible and responsiveness to changing workloads * Demonstrated skill in Customer Service and effective and tactful communications during stressful situations * Excellent interpersonal and communications skills * Proficiency with Microsoft Office suite * Fluency in written and spoken English and Arabic Fluency in other languages Sidra Medicine a healthy population is essential to a strong, prosperous society, and throughout 2020, Sidra continued to provide uninterrupted comprehensive specialist healthcare services for children and young people; and exceptional maternity, gynecology, and reproductive medical services for women, previously unavailable in Qatar and the region.” – H.H Sheikha Moza bint Nasser, Chairperson of Qatar Foundation Sidra Medicine represents the vision of Her Highness Sheikha Moza bint Nasser who serves as its Chairperson. This high-tech facility is home to world-class patient care, scientific expertise, and educational resources.

Responsibilities

The Pre-authorization Administrator is responsible for reviewing and validating insurance eligibility, coordinating prior authorizations, pre-certifications, and benefits, and maintaining ongoing communication with insurance companies. Key duties include verifying patient demographics, obtaining necessary documentation for medical necessity, and resolving insurance rejections.