Job purpose:
To train, monitor, supervise the pre-authorization team to ensure all agreed SLAs are met. To support with recruitment and training of new joiners, conduct quality audits on periodic basis and share feedback with the team. Generate, maintain, and publish TAT, Quality, case management trackers and dashboard.
Key Responsibilities
- To train, monitor, supervise the pre-authorization team to ensure all agreed SLAs are met.
- Mentoring and supporting the pre-approval team with their queries and concerns
- Implement process improvement ideas to make the process more efficient.
- Preparing and publishing TAT, Quality, case management and performance dashboards
Operational & technical responsibilities
- Monitors and achieves the pre-authorization SLA metrics.
- Recruitment and training of new joiners
- Query handling and providing feedback to the pre-authorization team.
- Preparing and publishing TAT, Quality, case management and performance dashboards
- Preparing duty roster for the team.
- Handle escalations from Sales, brokers, complaints and regulatory team.
- High level of working knowledge of healthcare regulations in UAE, BAH, OMN & QAT
- Basic knowledge of DRG and CPT/ICD is a must.
- Strong communication (verbal & written)
- Has sound knowledge of all medical insurance and guidelines.
- Understand the different aspects of the Healthcare Platform to be able to direct queries to the relevant parties where necessary.
- Sound knowledge of regulations from regulatory authority.
- Able to contribute significantly to the departmental savings.
Essential Requirement:
- MBBS degree holder or equivalent healthcare qualification
- Should have minimum 3 years experience in health insurance.
- Should have Minimum 3 yrs years experience in preapproval department.
- Good CPT, ICD and DRG knowledge
- Certification in Insurance in a plus
- Certification in medical coding is an advantage
