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Job Description
Transguard Group was established in 2001 and has diversified significantly, we lead in the fields of Cash Services, Security Services, Manpower Services, Facilities Management & Aviation. Transguard Group is the UAE’s most trusted business support and outsourcing provider and has a large, dynamic and culturally diverse workforce with 50,000 employees! We are currently recruiting for a Senior Officer - Medical Authorization to join our client team based out of Abu Dhabi Headquarters.
Job Profile-
The ideal candidate will be responsible for all aspects of the prior authorization process including collecting all the necessary documentation, contacting the customer/network provider for additional information and completion of the required prior authorization in order to proceed with service request. This job also requires to ensure complete, timely, and accurate identification and submission of prior and retro authorization requests.
Job Responsibilities-
- Verifies the requests with insurance policy; interpret medical information such as diseases or symptoms, and diagnostic descriptions and recommended procedures for treatment and determine if requested procedures are justified.
- Liaises with Supervisors, Officers and Medical Coding Coordinator to evaluate medical record documentations to ensure that diagnostic and recommended procedural codes accurately reflect and support the treatment of the disease or symptom, and to ensure that data comply with legal standards and guidelines.
- Approves medical authorization requests (as per delegated authority) if they comply with all stipulations and forward them to the Supervisors for final approval. Forward approved medical authorization requests to the provider and ensure proper record keeping.
- Handles all calls from Pharmacies or follow up calls on medical authorization. Support clients/providers on any medical authorization related queries, follow ups, emails or fax.
Rejection of Claims:
- Coordinates with Doctors/Providers on medical authorization procedure requests if they are not acceptable and recommend appropriate alternate approaches. Recommend rejection of request for the manager to approve along with justifications.
Skills
- GCC National/ Candidates who are well versed in Arabic(Speak, Read & Write mandatory)
- Educational background - MBBS
- Years of Experience - 5-7 Years