:

• 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.

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.

OHS ROLES & RESPONSIBILITIES:

• Responsible to be familiarize, comply and implement the OSHAD-SF& NMCSH Al Ain Internal OSHMS policies and procedures/SOP\'s relevant to their department.
• Staff should notify/report all OSHMS hazards, incidents, accidents and near misses within the premises of NMCSH Al Ain to their supervisor or department OSH Facilitator as per the incident reporting protocol of NMCSH Al Ain.
• Staff are responsible to assist with the preparation of departmental risk assessment activities and implement the control measure within the timeframe.
• Staff are responsible to attend applicable department OSHMS training.
• Staff are not allowed to tamper or misuse any NMCSH Al Ain equipment\'s and its property.
• Comply with all OSH instructions, safe working procedures and signages within the premises of NMCSH-Al Ain.
• Be familiar with emergency and evacuation procedure.
• Not willfully or recklessly endanger anyone\'s health and safety;
• Make proper use of all machinery, tools, substances, etc., safety systems and of all Personal Protective Equipment provided for use at work.
• Participate in required OSH inspection, audit and OSH monitoring programs.

Additional duties/responsibilities (related to ADHICS) assigned to this position in clear, concise language:Health Information Literacy and Skills: * Adhere to information systems policies and procedures as required by Health Care Organization.Privacy, Confidentiality of Health Information: * Follow security and privacy policies and procedures to the use of networks, including intranet and Internet.

• Follow confidentiality and security measures to protect electronic health information.
• Maintain data integrity and validity within an information system.
• Report any possible breaches of confidentiality in accordance with organizational policies.

Health Information/Data Technical Security: * Apply departmental and organizational data and information system security policiesBasic Computer Literacy Skills: * Use basic word processing, spreadsheet and desktop presentation applications as applicable to your work.

• Demonstrate proficiency in Windows operating environment.
• Demonstrate use of email, addressing, forwarding, attachments, netiquette

Qualifications:QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS :

• 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

NMC Healthcare