Hospitals & Health Systems;Medical Practices & Clinics
Description
About the job
KEY RESPONSIBILITIES AND DUTIES:Reviews and processes pre-authorization requests from healthcare providers (hospitals, laboratories, pharmacies) to determine if services are covered.
Verifies patient details and insurance eligibility for all pre-authorization requests.
Communicates approval or rejection decisions to healthcare providers and patients based on pre-established criteria.
Reviews medical documentation submitted with pre-authorization requests to confirm the medical necessity and compliance with insurance policies.
Maintains accurate records of all processed pre-authorization requests and ensures proper documentation for audits.
Resolves issues with incomplete or incorrect information related to pre-authorization requests.
Works closely with the claims and billing departments to ensure that pre-authorization approvals are aligned with the submission of insurance claims.
Responds to inquiries from patients, providers, and internal stakeholders regarding the status of pre-authorization requests.
Additional RequirementsCandidates MUST have proven clinical experience in Pre-Authorization, Insurance Verifcation or a related field in a healthcare setting for 2 -3 years.
Bachelor’s degree in a relevant field healthcare, business administration, or equivalent
2-3 years hospital/clinic experience in GCC
Arabic Speaker will be an advantage
Responsibilities
About the job
KEY RESPONSIBILITIES AND DUTIES:Reviews and processes pre-authorization requests from healthcare providers (hospitals, laboratories, pharmacies) to determine if services are covered.
Verifies patient details and insurance eligibility for all pre-authorization requests.
Communicates approval or rejection decisions to healthcare providers and patients based on pre-established criteria.
Reviews medical documentation submitted with pre-authorization requests to confirm the medical necessity and compliance with insurance policies.
Maintains accurate records of all processed pre-authorization requests and ensures proper documentation for audits.
Resolves issues with incomplete or incorrect information related to pre-authorization requests.
Works closely with the claims and billing departments to ensure that pre-authorization approvals are aligned with the submission of insurance claims.
Responds to inquiries from patients, providers, and internal stakeholders regarding the status of pre-authorization requests.
Additional RequirementsCandidates MUST have proven clinical experience in Pre-Authorization, Insurance Verifcation or a related field in a healthcare setting for 2 -3 years.
Bachelor’s degree in a relevant field healthcare, business administration, or equivalent
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