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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. |
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
