Junior RCM Officer ( Pre Authorization )
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Key skills for this role
Key Skills for This Role
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Key Responsibilities and Duties
- Review and process pre-authorization requests from hospitals, laboratories, and pharmacies to determine coverage.
- Verify patient details and insurance eligibility for all pre-authorization requests.
- Communicate approval or rejection decisions to providers and patients based on established criteria.
- Review medical documentation to confirm medical necessity and compliance with insurance policies.
- Maintain accurate records of processed requests and supporting documentation for audits.
- Resolve incomplete or incorrect information related to pre-authorization requests.
- Work with claims and billing departments to align approvals with insurance claim submissions.
- Respond to patient, provider, and internal stakeholder inquiries about request status.
Additional Requirements
- Two to three years of proven clinical experience in pre-authorization, insurance verification, or a related healthcare field.
- Bachelor's degree in a relevant field such as healthcare or business administration, or equivalent.
- Two to three years of hospital or clinic experience in the GCC.
- Arabic language skills are advantageous.
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