Approval Officer

About the role

Sunny Hamad Pharmacy Group is looking for an Approval Officer in Dubai. The role applies medical knowledge and insurance best practice to review and verify pre-approval requests (OP/IP) from various departments, obtaining authorizations according to each patient's plan coverage.

Key responsibilities

• Verify customer insurance eligibility and authorization accurately and on time, and communicate payer authorization and eligibility information.
• Complete service and procedure authorizations and referrals, and review the patient's medical history and insurance coverage.
• Contact referral physicians when needed, then notify the concerned staff and treating physicians once approval is obtained.
• Enter new patient information and update data in the system, and assist with other clerical work.
• Notify branch management of payer coverage or service non-coverage concerns, and keep the daily production report and the pending approvals monitoring system up to date.
• Guide doctors and staff to use the correct ICD, CDT and CPT codes to avoid rejections.

Required profile

• Diploma in any medical discipline or a related field.
• Minimum 2 years of experience in insurance claims management or pre-authorization processes.

Required skills

• Knowledge of medical coding standards, including ICD, CPT, DRG and HCPCS.