Summary
NMC Healthcare is seeking an Approval Officer in Abu Dhabi to review and audit medical claims for accuracy. The role includes resubmitting rejected claims, following up with doctors for justifications, and submitting correctly coded claims to insurers on time. Applicants should have a recognized medical or paramedical degree and at least 2 years of experience in insurance claims management or adjudication; medical coding experience is preferred. The title indicates the role is designated for UAE nationals.
The posting
As published on nmc.ae. Pulled from the employer's site and shown as they wrote it.
Administrative activities:
Administrative activities:
Review and Audit Medical Claims to ensure their accuracy.
Resubmission of rejected claims
Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
Submit the claims with proper codes and format to insurance companies within the stipulated time.
Responsibilities
Administrative activities:
Review and Audit Medical Claims to ensure their accuracy.
Resubmission of rejected claims
Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
Submit the claims with proper codes and format to insurance companies within the stipulated time.
Qualifications
Medical/paramedical (Nursing, pharmacy, etc..) graduate from a recognized university
Experience in Insurance Claims management/adjudication (minimum 2 years)
Experience in Medical Coding is preferable.
Flexible and able to work under pressure
Knowledge in using computer and related software applications and proficient in using MS office programs.