Approval Officer

About the role

Royal Medical Center Ras Al Khaimah is hiring an Approval Officer to handle pre-authorisation requests for patients. The role covers checking insurance eligibility, following up on rejected requests and keeping the approval process running smoothly.

Key responsibilities

• Handle rejected pre-authorisation requests, get the required justification from the treating doctor and resend them to the insurance company to obtain approval.
• Ensure pre-authorisation request details match regulators' standards, including claim adjudication and business rules.
• Verify customer insurance eligibility and authorisation accurately and in a timely way, and communicate payer information.
• Send payer correspondence, complete service and procedure authorisations and referrals, and review patient medical history and insurance coverage.
• Contact referral physicians when needed, notify staff and physicians once approval is obtained, and enter patient information into the system.
• Assist with other clerical work, notify branch management of coverage concerns, and keep the daily production report and pending approvals tracker up to date.
• Guide doctors and staff to use the correct ICD, CPT and CDT codes to avoid rejections.

Required profile

• College diploma in any discipline or a related field.
• Experience in insurance claims management or pre-authorisation processes, typically 2+ years.

Required skills

• Proficiency in medical coding standards: ICD, CPT, DRG and HCPCS.