Authorisation officer

Company : Daman - National Health Insurance Company

Job Type : Full Time

Abu Dhabi

Number of Applicants

:

000+

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Job Description - Authorisation officer

Assist Supervisor in ensuring that new guidelines, service/drug coding, updated policies and procedures that are related to duties of the coordinator are being properly implemented
Evaluate medical necessity of requested services according to medical data provided and accurately code service descriptions/drug codes stated on prior authorisation requests based on accepted medical coding rules/guidelines and policy’s schedule of benefits
Ensure that proper documentation of the data including business decisions are correctly done on the system with focus on accuracy, efficiency and quality
Constantly work on improving the TAT and relevant functional and personal competencies
Handle authorisation related issues/queries of health care providers or customers and providing them with appropriate assistance and guidance
Assist Supervisor in training new staff as per their function
Report suspected cases of fraud/abuse by healthcare providers to respective Supervisor
Evaluate and sign high cost authorisation letters from Medical Authorisation Coordinator as per his authority
Initiate the resolving of complex situations and issues at the coordinator level and take measures to avoid the reoccurrence of similar incidents
Handle changes in the workload flow from healthcare providers in terms of time, quantity and type of prior authorisation requests received with clear focus on quality and set target
Escalate cases needing Case Management intervention based on communicated criteria
Perform shift duty to ensure 24/7 operations of the department

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