Job Description

Description

The Pre-authorization Coordinator is responsible for verifying the eligibility, obtaining the insurance benefits; ensuring pre-authorization and referral requirements are met prior to Inpatient, Outpatient and Ancillary services.

Job Functions and Key Accountabilities:

Expertise in assigning accurate ICD-10-CM, CPT, DRG, HCPCS and other service codes for diagnosis and procedures performed in the Outpatient and Inpatient setting. Applying advanced knowledge of medical terminology , anatomy and physiology, treatment modalities , diagnostic test, medications Adhere to the HAAD 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 Insurance Company. Make sure all the Preauthorization Approval Requests are faxed across or 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 HIS, received from 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 Outpatient Manager RCM on a weekly basis for his/her advice and action. NICU alternate day rounds for DRG updates and revisions whenever required. Deriving appropriate initial DRG for Initial pre-authorization request. Excellent interpersonal skills while interacting with physicians, nurses and other staffs. Be a mentor for the team members and work with team to ensure high level of accuracy. Ensure high level of patient data confidentiality. Knowledge on Diagnosis related grouping Aware of current trends related to medical necessity , DRG and HAAD Claims and Adjudication rules and coding guidelines Utilizes tools available in 3M to ensure accurate coding. Ensure knowledge on deductibles, co-payments, co-insurance amounts, insurance exclusions and other policies of all insurances that Oasis Hospital is dealing with. Critical thinker with ability to perform root cause analysis, prepare and implement action plans and lead improvement initiative. Query physician for clarification and additional documentation prior to code assignment. Proper filing of approval copies to the medical record. Perform other related duties incidental to the work described herein.

Technical Competencies:

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 Preauthorization approval code in the HIS system in a timely manner. Ensures appropriate selection of principal diagnosis, qualifying secondary diagnosis, Impacting procedures and others services which is relevant for Preauthorization Approval Communicate with payers within 24-48hrs upon receiving the request from physician for approval.

Qualification

Education

: Degree in any related field preferably life science background. CPC (AAPC) certification will be a plus.

Experience

Experience

: Minimum of three (3) years handling all types of insurance preauthorization approvals in a clinic/hospital which operates in the UAE. In addition medical coding, knowledge of billing process will be a plus.