Fresh Gulf Job Find Better Jobs in Dubai UAE Qatar KSA Kuwait USA
Mubadala Health
Authorization Specialist Jobs in Abu Dhabi, UAE
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.
- Responsible to prepare the quotation in liaising with the clinical team and technicians for the required department and securing the approval within the KPI TAT.
- Manage correspondence with insurance companies, clinicians and patients as required.
- Document all prior authorization information including approval dates, prior authorization number in hospital system.
- Stay informed and research information regarding insurance criteria changes/updates for prior authorization.
- Respond to Insurance/ TPA on queries/rejections and coordinating with concerned department for additional documents/justifications.
- Provide daily and monthly reports as requested to track pre-authorization performance.
- Managing and handling the authorization TAT within the defined department KPI.
- If assigned to handle the claim audit, submit the claims to Shafafiya on a timely manner and respond to rejected claims for appropriate reimbursement.
- Communicate with payers on the authorization/claim level rejections and clarifications to enhance the claim quality.
- Ensure patients’ demographics and medical information are secure and comply with MH compliance and regulations.
- Report incidents, including near misses, to promote a learning culture within the organization.
- Adhere to recommended infection control practices to prevent health risks to colleagues, patients, families, and visitors.
- Remain flexible as MH is a dynamic organization, open to changes in service provision.
- Ensure staff compliance with organizational policies, processes, and procedures.
Qualifications
- Bachelor Degree from a recognized university.
- Minimum 2 years’ experience in the relevant department’s approval and adjudication
- Minimum 2 years’ experience in Insurance Claims management/rejection
- AAPC or AHIMA Certified Medical Coder with sound knowledge in coding for the relevant department
- Experience in Medical Coding ICD, CPT, DRG and HCPCS.
- Flexible and able to work under pressure.
To apply for this job please visit careers-m42.icims.com.
