PH DIAGNOSTICS LLC
Medical Insurance Coordinator (Approvals)
Roles & Responsibilities
Position at PH Diagnostics LLC The Pre-authorization Coordinator is responsible for verifying the eligibility, obtaining the insurance benefits; ensuring pre-authorization and referral requirements.
• Education: Degree in any related field preferably a life science background. CPC (AAPC) certification will be a plus.
• Duration and type of Experience: Minimum of three (1) years handling all types of insurance preauthorization approvals in a clinic/hospital which operates in the UAE. In addition to medical coding, knowledge of the billing process will be a plus.
Job functions and Key Accountabilities:
• Expertise in assigning accurate ICD-9-CM, CPT, and other service codes for diagnosis and procedures
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Recommended Interview Questions to Crack Any Interview:
• Applying advanced knowledge of medical terminology, anatomy and physiology, treatment modalities, diagnostic test
• Adhere to the DHA Claims and Adjudication rules and coding guidelines
• Work closely with Physicians, Nurses, Coders, and Registration to obtain information related to patients which requires approval from the Insurance Company.
• Make sure all the Preauthorization Approval Requests are applied online to the specific insurance company or TPA.
• Each Preauthorization Approval must be read immediately after receipt and its contents must be fully understood in order to avoid any possible discrepancy.
• Update the Preauthorization approval code in the system, received from the Insurance Company immediately after receipt.
• Provides feedback to physicians regarding payers’ query on specific request.
• Check all the pending, approved, and rejected approvals and extensions on a daily basis.
• Maintain a discrepancy report on a daily basis and discuss all the discrepancies and related concerns with the Center Manager RCM on a weekly basis for his/her advice and action.
• Excellent interpersonal skills while interacting with physicians, nurses, and other staff.
• Be a mentor for the team members and work with the team to ensure a high level of accuracy.
• Ensure a high level of patient data confidentiality.
• Knowledge of Diagnosis-related grouping
• Ensure knowledge of deductibles, co-payments, co-insurance amounts, insurance exclusions, and other policies of all insurances.
• Critical thinker with the ability to perform root cause analysis, prepare and implement action plans and lead improvement initiatives.
• Query referring physician for clarification and additional documentation prior to code assignment.
• Proper filing of approval copies of the medical record.
• Perform other related duties incidental to the work described herein.
• Provides detailed and timely communication to both payers and physicians in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient’s record and updating the pre-authorization approval code in the system in a timely manner.
• Ensures appropriate selection of principal diagnosis, qualifying secondary diagnosis, Impacting procedures, and other services which is relevant for Preauthorization Approval
• Communicate with payers within 4-6 hrs upon receiving the request from a physician for approval
Department / Functional Area
To apply for this job please visit www.naukrigulf.com.