Pre-Approval Officer | Al Futtaim Health | Healthcare

Job Requisition ID: 180207

Established in the 1930s as a trading business, Al-Futtaim Group today is one of the most diversified and progressive, privately held regional businesses headquartered in Dubai, United Arab Emirates. Structured into five operating divisions; automotive, financial services, real estate, retail and healthcare; employing more than 35,000 employees across more than 20 countries in the Middle East, Asia and Africa, Al-Futtaim Group partners with over 200 of the world's most admired and innovative brands. Al-Futtaim Group’s entrepreneurship and relentless customer focus enables the organization to continue to grow and expand; responding to the changing needs of our customers within the societies in which we operate.

By upholding our values of respect, excellence, collaboration and integrity; Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day

What You Will Do

• Review all claim forms which is assigned on the dashboard and provide adequate feedback on the same.
• Update Approvals received from Insurance companies with 100% accuracy
• Communicating with departments in case of any missing document or more information required
• -Meet daily claims verification productivity
• -Quantitative analysis – Perform a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
• Follows coding guidelines and legal requirements to ensure compliance with regulatory guidelines
• Qualitative analysis – Evaluate the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review the records for compliance with established third party reimbursement agencies and special screening criteria
• Receive the patient medical record on daily basis and check any deficiency in documentation, if any, notify the concerned staff and send it to physician
• Receive the completed records and ensure that the marked deficiencies are cleared and follow the standards
• Timely submissions of all preapprovals as per KPIs
• Improve the quality of pre-approval submission to obtain approval from the first round.
• The role also include stop revenue loss through monitoring and coordination with all concerned stakeholders like coding team and physicians to revise IC rejections.
• Monitor behavioural approval processes of various payors and corporates to apply customized actions to obtain pre-approvals.
• Ensure all pre-approvals are submitted of all eligible IP,OP and pharmacy to IC/TPA
• Internal Follow up for additional information required by insurance company
• Interacting with the physicians for the clinical justification of the pre=approvals.
• Ensure and work closely with the team on complex cases to obtain faster approval from payers.
• Making sure that PAR submissions are dealt with according to Insurance industry and DHA regulations.
• Comply with pre-approval KPI’s (Key Performance Indicator) , maintain a record of pre-approval KPIs as and when required.
• Educate billing/Approval team to enhance the process flow.
• Ensures that targets are met within turnaround time and while maintaining quality and productivity.
• Coordinate with CDI team to educate the physicians , and other paramedical team to ensure proper claims documentations.
• Maintain accurate monthly data of claims submissions of each insurance company
• Coordination with other business stakeholders to improve overall submission process efficiency.
• Analysis of financial data related to revenue cycle, to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risk/s .
  
  

Required Skills To Be Successful

• Strong medical background to handle reconciliation efficiently.
• Strong Negotiation skills
• Strong soft skills
  
  

About The Team

The role will report to the Revenue Cycle Manager, The Pre-Approval will assist the review and and update of claims and approvals received from the insurance companiesm, serves as a point of contact between the revenue cycle department and the medical staff in the clinics.

What Equips You For The Role

• Minimum 3+ years’ experience in a similar role.
• Certified professional coding certificate from reputed institution
  
  

About Al-Futtaim Healthcare

We Hear Your Ambition.

For over 90 years, the Al-Futtaim Group has been bringing the world’s leading brands of lifestyle watches, cars, home furnishings and fashion to the UAE. The Group has now introduced a whole new way of holistic healthcare through HealthHub Clinics by Al-Futtaim, its multi-speciality chain of more than 20 clinics in Dubai with over 25 specialties offering the right combination of advanced diagnostics, proven medical expertise and specialised services.

What gives our clinics an edge is that as a part of the Al-Futtaim Group, you can expect world-class quality standards, with access to the best medical services and facilities within a healing environment. It’s a new way of healthcare that’s designed to meet a patient’s needs with a complete range of smart healthcare solutions. As testimony to this, only recently, we’ve earned a rare milestone of being the only primary healthcare network in the UAE to receive the Gold Seal by a reputed international body: Accreditation Canada.

As trusted partners to health, we at HealthHub Clinics adopt evidence-based learning that enables us to listen to our patients more carefully. It helps us in treating the cause and not just the symptoms, while applying global best practices to ensure quality of care for every family member. Most of all, we adopt a patient-centric approach to healthcare that is reflected in the promise of our core belief: “We Hear You.”