Job Description

Senior Officer - Medical Audit and Cost Optimization Roles & Responsibilities:

1. Auditing Prior authorization requests as per international coding guidelines & close monitoring on TPAs approval.

2. Perform regular Coding Quality Check on approvals generated by the Authorization Unit.

3. Ensuring accuracy of DRG codes submitted from providers in terms of ICD, CPT and severity level.

4. Liaising with TPAs for day-to-day queries related to approvals from insured / brokers.

5. Assist in managing Pre-authorization business to optimize cost efficiencies subject to medical policy eligibility.

6. Case Management by doing utilization review anddischarge planning.

7. Decision making on high cost and complicated cases.

8 . Manage Regulatory complaints.

9. Conduct audit and report on TPA claims adjudication management system end to end.

10. Evaluates medical records documentation to ensure the diagnostic and procedural codes accurately reflect and supports the reason for encounter and to ensure that data comply with legal standards and guidelines.

11. Interprets medical information such as disease or symptoms, and diagnosis descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD 9/10 CM and CPT codes.

Qualifications and Skills

1. Bachelor's degree in medical field or related.

2. Minimum of 2- 3 years of experience in Medical Claims & Approvals, preferably in an Insurance Company or TPA setting in UAE.

3. Strong organizational and multitasking skills.

4. Excellent communication and interpersonal skills in Arabic.

5. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).

6. Ability to work independently and as part of a team.

7. Strong problem-solving skills and attention to detail.

Location | This position is based in the Dubai Head Office.

Interested candidates may share their CV's on careers@takafulemarat.com with the job code in the Subject MC0724

Job Type: Full-time

Education:

• Bachelor's (Preferred)

Experience:

• Insurance company or TPA in UAE: 2 years (Required)

Location:

• Dubai (Required)

Application Deadline: 31/07/2024