Authorisation officer

4 months ago


Abu Dhabi, United Arab Emirates Daman - National Health Insurance Company Full time
  • Assist Supervisor in ensuring thatnew guidelines, service/drug coding, updated policies andprocedures that are related to duties of the coordinator are beingproperly implemented
  • Evaluate medical necessityof requested services according to medical data provided andaccurately code service descriptions/drug codes stated on priorauthorisation requests based on accepted medical codingrules/guidelines and policy’s schedule ofbenefits
  • Ensure that proper documentation ofthe data including business decisions are correctly done on thesystem with focus on accuracy, efficiency andquality
  • Constantly work on improving the TATand relevant functional and personalcompetencies
  • Handle authorisation relatedissues/queries of health care providers or customers and providingthem with appropriate assistance andguidance
  • Assist Supervisor in training newstaff as per their function
  • Report suspectedcases of fraud/abuse by healthcare providers to respectiveSupervisor
  • Evaluate and sign high costauthorisation letters from Medical Authorisation Coordinator as perhis authority
  • Initiate the resolving of complexsituations and issues at the coordinator level and take measures toavoid the reoccurrence of similarincidents
  • Handle changes in the workload flowfrom healthcare providers in terms of time, quantity and type ofprior authorisation requests received with clear focus on qualityand set target
  • Escalate cases needing CaseManagement intervention based on communicatedcriteria
  • Perform shift duty to ensure 24/7operations of the department

  • Authorisation officer

    4 months ago


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