Pre-Approval Officer

Website Al Futtaim Careers

Job Description:

By upholding our values of respect, excellence, collaboration and integrity; Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day

Job Responsibilities:

  • Monitor behavioural approval processes of various payors and corporates to apply customized actions to obtain pre-approvals.
  • Ensure all pre-approvals are submitted of all eligible IP,OP and pharmacy to IC/TPA
  • Internal Follow up for additional information required by insurance company
  • Interacting with the physicians for the clinical justification of the pre=approvals.
  • Ensure and work closely with the team on complex cases to obtain faster approval from payers.
  • Making sure that PAR submissions are dealt with according to Insurance industry and DHA regulations.
  • Comply with pre-approval KPI’s (Key Performance Indicator) , maintain a record of pre-approval KPIs as and when required.
  • Qualitative analysis – Evaluate the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review the records for compliance with established third party reimbursement agencies and special screening criteria
  • Receive the patient medical record on daily basis and check any deficiency in documentation, if any, notify the concerned staff and send it to physician
  • Receive the completed records and ensure that the marked deficiencies are cleared and follow the standards
  • Timely submissions of all preapprovals as per KPIs
  • Educate billing/Approval team to enhance the process flow.
  • Ensures that targets are met within turnaround time and while maintaining quality and productivity.
  • Coordinate with CDI team to educate the physicians , and other paramedical team to ensure proper claims documentations.
  • Review all claim forms which is assigned on the dashboard and provide adequate feedback on the same.
  • Update Approvals received from Insurance companies with 100% accuracy
  • Communicating with departments in case of any missing document or more information required

Job Requirements:

  • Minimum 3+ years’ experience in a similar role.
  • Strong medical background to handle reconciliation efficiently.
  • Strong Negotiation skills
  • Strong soft skills
  • Certified professional coding certificate from reputed institution

Job Details:

Company: Al Futtaim Careers

Vacancy Type: Full Time

Job Location: Dubai, UAE

Application Deadline: N/A

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