Summary
NMC Healthcare is seeking a Medical Approval Officer in Al Ain, United Arab Emirates. The role involves reviewing pre-approval requests for medical necessity, coding services, responding to insurer and TPA queries, and managing second-opinion and case-management requests. The officer also supports audits, prepares activity reports and cost estimates, and trains front-office staff and nurses on insurance matters. Applicants need an MBBS, at least 2 years of insurance claims management or adjudication experience, medical coding knowledge, and strong English; night shifts and public-holiday duties are part of the roster.
The posting
As published on nmc.ae. Pulled from the employer's site and shown as they wrote it.
DUTIES AND 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, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits
Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
Responsible for receiving, evaluating and escalating second opinion cases and case management
Perform night shift duty and on public holidays as per duty roster.
Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors
Attend Meetings and Presentation
Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
Prepare cost estimate for procedures for Cash Patient
To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
Managing and handling pending cases (if any) to the next shift colleagues.
Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
Responsibilities
DUTIES AND 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, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits
Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
Responsible for receiving, evaluating and escalating second opinion cases and case management
Perform night shift duty and on public holidays as per duty roster.
Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors
Attend Meetings and Presentation
Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
Prepare cost estimate for procedures for Cash Patient
To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
Managing and handling pending cases (if any) to the next shift colleagues.
Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
Qualifications
Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
Experience in Insurance Claims management/adjudication (minimum 2 years)
Experience in Medical Coding ICD, CPT, DRG and HCPCS.
Excellent command of oral and written English.
Flexible and able to work under pressure
Excellent knowledge of Microsoft applications