Holders of the Guinness World Record for the "Largest Fireworks Display" ever recorded and "Largest Pyrotechnic Image", Fireworks by Grucci is a sixth-generation, family-owned and operated company. Known as "America's First Family of Fireworks," the Gruccis have transformed the night skies to the delight of millions across the globe since 1850. They are world-renowned for pyrotechnic artistry, scientific innovation and old-fashioned values. Their signature performances include the official celebration of the 200th Anniversary of the National Anthem “Star Spangled Spectacular,†in Baltimore, countless performances in and around Las Vegas, NV., seven consecutive U.S. Presidential Inaugurations; the Olympic Games in Beijing, Salt Lake City, Los Angeles and Lake Placid; commemorations such as the Centennial of the Statue of Liberty and star-studded extravaganzas including the grand opening of the Atlantis Dubai and the Palm Jumeirah Island in the United Arab Emirates. On New Year’s Eve 2013, a stunning performance displaying 479,651 fireworks made its debut above Dubai’s iconic skyline. The Gruccis achieved their “Largest Fireworks Display†title with this performance and smashed the Guinness Book of World Record’s preceding mark. Phil Grucci currently serves as President/CEO of Fireworks by Grucci, Inc. and Pyrotechnique by Grucci, Inc., the manufacturing entity of the Grucci group of companies.... |
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 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
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
Response to Insurance/ TPA queries and liaise with concerned department.
Responsible for receiving, evaluating and escalating second opinion cases and case management
Perform night shift duty to sustain any issues and queries related to Authorization department
Prepares reports of daily activity as requested for management and assists management in monthly reports as requested
Qualifications
Bachelor Degree in Medicane (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
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.
Responsibilities
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
Response to Insurance/ TPA queries and liaise with concerned department.
Responsible for receiving, evaluating and escalating second opinion cases and case management
Perform night shift duty to sustain any issues and queries related to Authorization department
Prepares reports of daily activity as requested for management and assists management in monthly reports as requested
Qualifications
Bachelor Degree in Medicane (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
