Approval Officer
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Key skills for this role
About the Role
NMC Health plc is seeking an Approval Officer in Abu Dhabi to review and verify pre-approval requests for medical services. The role requires a Bachelor's degree in Medicine (MBBS) and at least 2 years of experience in insurance claims management.
Key Skills for This Role
Responsibilities
- Review and verify Pre Approval requests (OP/IP) to obtain authorizations from insurance companies
- Handle rejected pre authorizations and obtain justification from treating doctors to resend and obtain approval
- Prepare reports of daily activity for management and assist in month end reporting
- Evaluate pre approval requests for medical necessity and assign coding
- Respond promptly to insurance companies and TPAs
- Perform night shift duties and work on public holidays as per roster
- Conduct training sessions for front office staff on insurance policies
- Prepare cost estimates for procedures for cash paying patients
Requirements
- Bachelor's Degree in Medicine (MBBS) from a recognized university
- Minimum 2 years of experience in Insurance Claims Management and/or Adjudication
- Strong knowledge and experience in medical coding systems, including ICD, CPT, DRG, and HCPCS
- Excellent verbal and written communication skills in English
- Flexible, adaptable, and able to work under pressure
- Proficient in Microsoft Office applications
Full Job Posting
Key Responsibilities
- Apply medical knowledge and best insurance practice while reviewing and verifying Pre Approval requests (OP/IP) from different departments to obtain authorizations as required by insurance companies.
- 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.
- Evaluate pre approval requests for medical necessity based on submitted clinical documentation and accurately assign coding.
- 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.
- Conduct training sessions for front office staff, receptionists, and nurses.
- Prepare cost estimates for procedures and services for cash paying patients.
- Provide coverage and adjust duties during emergency or unplanned staff absences.
Qualifications
- Bachelor's Degree in Medicine (MBBS) from a recognized university.
- Minimum 2 years of experience in Insurance Claims Management and/or Adjudication.
- Strong knowledge and experience in medical coding systems, including ICD, CPT, DRG, and HCPCS.
- Excellent verbal and written communication skills in English.
- Flexible, adaptable, and able to work effectively under pressure.
- Proficient in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
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