Medical Authorization Specialist

4 weeks ago


Dubai, Dubai, United Arab Emirates Jobs via eFinancialCareers · Full time

OVERVIEW: The Medical Authorization Specialist plays a crucial role in securing prior approvals for various medical procedures by efficiently navigating the authorization process with diverse commercial insurers, ensuring adherence to established turnaround times to uphold team performance metrics.

KEY RESPONSIBILITIES:

  • Evaluate the necessity of medical approvals and the application of relevant policies.
  • Confirm that the proposed treatment plan is essential for the patient’s health.
  • Regularly document both verbal and written claims approvals.
  • Make determinations based on policy stipulations.
  • Assess high-value claims and render decisions on complex cases.
  • Provide clear and concise feedback to inquiries from the call center team.
  • Educate clients on the reasons behind any denied medical claims.
  • Coordinate workflow effectively to meet established deadlines.
  • Review claims for eligibility criteria.
  • Achieve daily productivity targets for Precertification based on claim types and tenure.
  • Process Outpatient Precertification on a first-in-first-out basis.
  • Maintain a productivity turnaround time of 85% within 10 minutes and 98% within the first hour, including urgent and VIP cases.
  • Exhibit 100% adherence to schedules and punctuality.
  • Engage in decision-making responsibilities.
  • Thoroughly evaluate high-cost claims to meet daily team targets, ensuring approvals align with guidelines and policy conditions, while considering market practices, with significant accountability for invalid rejections and customer satisfaction.
  • Assist in training new team members and provide constructive feedback.
  • Keep the workflow guidelines updated for accuracy and efficiency.

QUALIFICATIONS:

  • Bachelor’s degree in Pharmacy.
  • A minimum of 4 years of relevant medical experience, preferably with a reputable insurance provider, broker, or TPA.
  • Proficiency in MS Office applications (Excel, Word, Outlook, PowerPoint) and adeptness in general internet navigation and research skills.


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