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Approval Officer

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NMC Healthcare

Sep 20

Applications are closed

  • Job
    Full-time
    Junior Level
  • Accounting & Tax
    Healthcare

Requirements

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

Responsibilities

  • 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 Insurance 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 Insurance Company and obtain the approval.
  • Prepares reports of daily activity as requested for management and assists management in month end reporting as requested.
  • 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’s schedule of benefits.
  • Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
  • Responsible for receiving, evaluating and escalating second opinion cases and case management.
  • Perform night shift duty and on public holidays as per duty roster.
  • Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
  • Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors.
  • Attend Meetings and Presentation.
  • Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
  • Prepare cost estimate for procedures for Cash Patient.
  • To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
  • Managing and handling pending cases (if any) to the next shift colleagues.
  • Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
  • Responsible to be familiarize, comply and implement the OSHAD-SF& NMCSH Al Ain Internal OSHMS policies and procedures/SOP’s relevant to their department.
  • Staff should notify/report all OSHMS hazards, incidents, accidents and near misses within the premises of NMCSH Al Ain to their supervisor or department OSH Facilitator as per the incident reporting protocol of NMCSH Al Ain.
  • Staff are responsible to assist with the preparation of departmental risk assessment activities and implement the control measure within the timeframe.
  • Staff are responsible to attend applicable department OSHMS training.
  • Staff are not allowed to tamper or misuse any NMCSH Al Ain equipment’s and its property.
  • Comply with all OSH instructions, safe working procedures and signages within the premises of NMCSH-Al Ain.
  • Be familiar with emergency and evacuation procedure.
  • Not willfully or recklessly endanger anyone's health and safety;
  • Make proper use of all machinery, tools, substances, etc., safety systems and of all Personal Protective Equipment provided for use at work.
  • Participate in required OSH inspection, audit and OSH monitoring programs.
  • Adhere to information systems policies and procedures as required by Health Care Organization.
  • Follow security and privacy policies and procedures to the use of networks, including intranet and Internet.
  • Follow confidentiality and security measures to protect electronic health information.
  • Maintain data integrity and validity within an information system.
  • Report any possible breaches of confidentiality in accordance with organizational policies.
  • Apply departmental and organizational data and information system security policies.
  • Use basic word processing, spreadsheet and desktop presentation applications as applicable to your work.
  • Demonstrate proficiency in Windows operating environment.
  • Demonstrate use of email, addressing, forwarding, attachments, netiquette.

FAQs

What qualifications are required for the Approval Officer position?

A Bachelor Degree in Medicine (MBBS) from a recognized university is required.

What experience is necessary for this role?

A minimum of 2 years of experience in Insurance Claims management/adjudication is necessary.

Is experience in medical coding required for the Approval Officer position?

Yes, experience in Medical Coding, including ICD, CPT, DRG, and HCPCS, is required.

What skills are essential for this job?

Excellent command of oral and written English, flexibility to work under pressure, and strong knowledge of Microsoft applications are essential skills.

Does this position require night shifts or work on public holidays?

Yes, the Approval Officer may need to perform night shift duties and work on public holidays as per the duty roster.

Are there any responsibilities related to occupational health and safety?

Yes, the Approval Officer must comply with OSH policies and procedures relevant to their department and report any hazards or incidents.

What are the reporting responsibilities of the Approval Officer?

The Approval Officer prepares reports of daily activity as requested for management and assists with monthly reporting.

Will the Approval Officer need to train other staff?

Yes, the Approval Officer is responsible for training front office, receptionists, and nurses on insurance details.

Is prior experience with TPA queries relevant for this position?

Yes, experience in responding to Insurance/TPA queries is relevant and necessary for this job.

What type of computer literacy is expected for this role?

Proficiency in basic word processing, spreadsheet, and desktop presentation applications, as well as familiarity with email use, is expected.

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NMC Healthcare

Delivering personalised care that matters.

Science & Healthcare
Industry
10,001+
Employees
1974
Founded Year

Mission & Purpose

NMC Healthcare is one of the largest private healthcare networks in the United Arab Emirates, and the third largest in Oman. Since 1975, we have provided high quality, personalised, and compassionate care to our patients and are proud to have earned the trust of millions of people in the UAE and around the world. ---------------------------------------- DISCLAIMER: Fraudulent Job Offers ---------------------------------------- It has come to our attention that fake job offers have been circulated under the name of NMC Healthcare by certain individuals/entities claiming that they are representatives or subsidiaries or under contract with NMC Healthcare. If you receive any unauthorised, suspicious, or fraudulent offers or interview calls, please send an email to verification@nmc.ae for formal verification. If you believe you have been a victim of a recruitment fraud, you are encouraged to approach the law enforcement agencies immediately.

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