Insurance - Approvals

NMC Healthcare | Ras al-Khaimah | AE

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If this job matches your qualifications, please send your application directly through our latest Job site. Indeed, every job is not easy to apply because it must meet several qualifications and requirements that we must meet in accordance with the standard criteria of the Company who are looking for potential candidates to work. Good job information Insurance - Approvals - NMC Healthcare below matches your qualifications. Good Luck: D

Apply medical knowledge and best insurance practice while reviewing and verifying the Pre-Approval requests (OP/ IP) received from different departments to…...

Hamster Kombat
  • Apply medical knowledge and best insurance practice while reviewing and verifying the Pre-Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details of the Pre-Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
  • Handling the rejected pre-authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval. Prepares reports of daily activity as requested for management and assists management in month end reporting as requested
  • 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 Presentations.
  • 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.
  • Bachelor’s Degree with PCP Coding

Information :

  • Company : NMC Healthcare
  • Position : Insurance - Approvals
  • Location : Ras al-Khaimah
  • Country : AE

How to Submit an Application:

After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Insurance - Approvals job info - NMC Healthcare Ras al-Khaimah above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Insurance - Approvals job info - NMC Healthcare Ras al-Khaimah in 24-05-2024 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via the Next Page link below.

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Post Date : 24-05-2024

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