:

• Manages insurance approvals for insured patients both Inpatient & out patient. Liaises between NMC Royal Hospital, Sharjah, and Insurance Companies.

Responsibilities:

• Follows insurance protocols and procedures.
• Coordinates with clinicians and/or other clinical staff for gathering information/documentation for submission.
• Liaises with Insurance Companies/TPAs for submitting, resubmitting, and replying queries raised by Insurance Companies/TPAs efficiently.
• knowledge in pronouncing and understanding medical terminologies.
• Demonstrate strong attention to details and ability to multitask within the fast- paced, high-pressure work environment.
• Manage and track approval/denials/queries and inform clinicians and patients about the requested service(s) status.
• Prepares cost estimation accurately for approvals as per the agreed terms.
• To maintain an active database of the instructions/communication about Insurance Companies/TPAs from RCM Office.
• Practices professional telephone etiquette both internal and external stake holders while making claim inquires and quickly resolving any patient complaints and concerns
• Provides aid to Front Desk Staff regarding Insurance Protocols and Coverage.
• Knowledge and ability to adopt/utilize computer-based applications and Microsoft Office.
• Maintains strict confidentiality related to medical records and other data.
• Procuring, Validating, and sending all the required information and documents while requesting preapproval from insurance companies through email, fax or online portals.
• Procuring, validating, and sending all the required info/documents while requesting pre-approval from insurance companies through email, fax, or online portals.
• Knowledgeable about medical coding guidelines and coding techniques (ICD10CM, CPT, HCPCS).
• Analysing the medical data and entering it in the form of precise medical codes in online portals like e-Claim/DHPO, NeXT Care, Nas, etc. and in the Hospital Management Software.
• Coordinating with claims team for coding updates and updated guiding principles.
• Observing the quality parameters regularly and ensuring that the quality of coding work is maintained at a higher rate.
• Taking pre-approval for in-patient (whenever necessary) & out-patient procedures, laboratory investigations, maternity, dental and optical cases as per the Insurance
• Companies specific coverage.
• Collaborate with doctors and other medical practitioners within the medical team regarding medical conditions that require specific indication on every approval (Inpatient and Outpatient).
• Meet all key performance indicators set for call/claim handling (meet call/claim production call/claim quality, system adherence and attendance, complete call log, manage call reports).
• Reviewing patient's medical reports, member policy and giving internal approvals wherever necessary without any delay.
• Reviewing the patient's medical history and replying to the queries from insurance companies, whenever there is a delay from the doctor side to reply to the query
• Communicating with the insurance companies and checking with them whenever there is discrepancy in the approved amount (when approval is not as per agreed

Qualifications:

• Bachelor's degree from an accredited college / university. Coding and claims processing skills will be preferred.
• Minimum 2 years' experience in a similar environment and similar role.
• Knowledge of medical coding, Medical Billing, Insurance Policies and Protocols.

Experience in MS Office
Able to achieve office goals by working efficiently & providing a high level of Patient Services
Communication Skills.

NMC Healthcare