Approval Officer
Job Fit Check
Base Career helps you apply smarter for this job.
Key skills for this role
About the Role
2.1 Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizat.
Key Skills for This Role
Responsibilities
- Apply medical knowledge and best insurance practice while reviewing and verifying Pre Approval requests
- Handle rejected pre authorization and get required justification from treating doctor
- Prepare reports of daily activity as requested for management
- Evaluate pre approval requests for medical necessity based on submitted clinical documentation
- Respond promptly to insurance companies and TPAs
- Perform night shift duties and work on public holidays as per approved duty roster
- Prepare daily activity reports and support management with monthly reporting
- Coordinate and support internal and external auditing processes
- Conduct training sessions for front office staff, receptionists, and nurses
- Prepare cost estimates for procedures and services for cash paying patients
Requirements
- Apply medical knowledge and best insurance practice while reviewing and verifying Pre Approval requests
- Handle rejected pre authorization and get required justification from treating doctor
- Prepare reports of daily activity as requested for management
- Evaluate pre approval requests for medical necessity based on submitted clinical documentation
- Respond promptly to insurance companies and TPAs
- Perform night shift duties and work on public holidays as per approved duty roster
- Prepare daily activity reports and support management with monthly reporting
- Coordinate and support internal and external auditing processes
- Conduct training sessions for front office staff, receptionists, and nurses
- Prepare cost estimates for procedures and services for cash paying patients
Full Job Posting
Overview
- 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
- 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 pre approval requests for medical necessity based on submitted clinical documentation and accurately assign coding for requested services in accordance with accepted medical coding standards, medical guidelines, and policy benefits.
- Respond promptly to insurance companies and TPAs, and coordinate with relevant departments as required.
- Receive, assess, and escalate second opinion cases and case management requests.
- Perform night shift duties and work on public holidays as per the approved duty roster.
- Prepare daily activity reports and support management with monthly reporting requirements.
- Coordinate and support internal and external auditing processes by arranging required documentation and liaising with coding staff.
- Attend meetings, presentations, and departmental discussions as required.
- Conduct training sessions for front office staff, receptionists, and nurses, ensuring they remain updated on insurance policies and procedures.
- Prepare cost estimates for procedures and services for cash paying patients.
- Provide coverage and adjust duties during emergency or unplanned staff absences.
- Ensure smooth handover and management of pending cases to subsequent shifts.
- Perform additional duties assigned by the Head of Department within the scope of the role.
Compliance Requirements
- Comply with all Occupational Safety and Health (OSH) and Infection Control policies, procedures, and standards.
- Follow documented OSH procedures and fulfill assigned safety responsibilities.
- Maintain awareness of emergency response and evacuation procedures.
- Report OSH hazards, incidents, near misses, and assist in risk assessments and incident investigations.
- Adhere to waste management policies and procedures.
- Participate in mandatory OSH, Infection Control training programs, mock drills, and awareness initiatives.
- Utilize appropriate personal protective equipment (PPE) and safety systems at all times.
Apply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at NMC healthcare LLC
Clinic Support Assistant
Abu Dhabi, UAE
To assist Physician in clinic including accessing, adding, and modifying the patient medical records under the physician’s supervision. Request the necessary investigation for t...
Registered Nurse - ER
Dubai, UAE
The post holder will always work within the scope of practice, putting the health, wellbeing and safety of their patient first as they assess, plan, implement and evaluate their...
Specialist - Radiology
Abu Dhabi, UAE
The role involves delivering professional, ethical, and high-quality clinical care, managing clinical risks, ensuring compliance with governance standards, and maintaining accur...
Call Center Supervisor
Dubai, UAE
You will be the first point of contact for our patients, providing them with exceptional customer service and support. Ensuring calls to and from the hospital are attended promp...
Physiotherapist
Al Ain, UAE
Undertake duties in accordance with the philosophy, business practices and policies of NMCSH-Al-Ain, and practicing within the standards and ethics of the Physiotherapy professi...
Specialist Child Psychiatry
Abu Dhabi, UAE
The role involves delivering professional, ethical, and high-quality clinical care, managing clinical risks, ensuring compliance with governance standards, and maintaining accur...
Specialist Psychiatry
Abu Dhabi, UAE
The role involves delivering professional, ethical, and high-quality clinical care, managing clinical risks, ensuring compliance with governance standards, and maintaining accur...
Caregiver
Abu Dhabi, UAE
The patient aide will work to support the nursing staff to provide for the everyday needs of the resident’s and their families Responsibilities Responsibilities may vary dependi...
Clinic Support Assistant
Abu Dhabi, UAE
Registered Nurse - ER
Dubai, UAE
Specialist - Radiology
Abu Dhabi, UAE
Call Center Supervisor
Dubai, UAE
Physiotherapist
Al Ain, UAE
Specialist Child Psychiatry
Abu Dhabi, UAE
Specialist Psychiatry
Abu Dhabi, UAE
Caregiver
Abu Dhabi, UAE