Approval Officer

About the role

Speciality Hospital Abu Dhabi is looking for an Approval Officer to handle pre-authorization requests for medical services. The role involves assessing medical necessity, coding services according to accepted medical coding rules and the policy's schedule of benefits, and responding to insurance and TPA queries.

Key responsibilities

• Evaluate pre-authorization requests for medical necessity based on the medical data provided and code the service descriptions according to accepted medical coding rules, medical guidelines and the policy's schedule of benefits.
• Respond to insurance and TPA queries and liaise with the concerned departments.
• Receive, evaluate and escalate second opinion cases and case management requests.
• Perform night shift duties to address issues and queries related to the Authorization Department.
• Prepare daily activity reports as requested by management and assist with monthly reporting.

Required profile

• Bachelor's degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years of experience in insurance claims management or adjudication.
• Excellent command of written and spoken English.
• Flexible and able to work under pressure.

Required skills

• Medical coding experience (ICD, CPT, DRG and HCPCS).
• Excellent knowledge of Microsoft Office applications.