Approval Officer

Bachelor of Business Administration (Management)

Nationality: Any Nationality

Vacancy: 1 Vacancy

Job Location: United Arab Emirates

Experience: 4 to 12 years

Job Function: Doctor / Medical Research / Dean / Medical Professors, Insurance / Claims

Skillset: Insurance Claims Experience

Jobseekers from any country

Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all patients.

Ensure that the details of the Pre Authorization Requests are in line with the regulators' standards, especially the claim adjudication Rules and Business Rules.

Handling the rejected pre-authorization and get required justification from the treating doctor to resend it to the Insurance Company and obtain the approval.

Prepares reports of daily activity as requested for management and assists management in month-end reporting as requested.

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 schedule of benefits.
2. Respond to Insurance/TPA queries and liaise with the concerned department.
3. Responsible for receiving, evaluating and escalating second opinion cases and case management.
4. Perform night shift duty to sustain any issues and queries related to the Authorization department.
5. Prepare reports of daily activity as requested for management and assist management in monthly reports as requested.

Qualifications:

1. Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
2. Experience in Insurance Claims management/adjudication (minimum 2 years).
3. Experience in Medical Coding ICD, CPT, DRG and HCPCS.
4. Excellent command of oral and written English.
5. Flexible and able to work under pressure.
6. Excellent knowledge of Microsoft applications.

You will be redirected to the company website to apply for this position.

Company Industry:

• Medical
• Medical Devices

Department / Functional Area:

• Administration

Keywords:

• Approval Officer