Job Description

Kanad Hospital (formerly known as Oasis Hospital) was established in 1960 by Doctors Pat and Mariam Kennedy at the request of HH Sheikh Zayed Al Nahyan. The Kennedys were physicians from the United States whose primary goal was to honor God by providing loving healthcare to those in this region. Ever since our launch, Kanad has been known for its excellent obstetric and pediatric care, and we are proud to be recognized as one of the premier healthcare providers for women and children in the Middle East. We are honored to be the birthplace of many of the leaders of our great nation including HH Sheikh Mohamed bin Zayed Al Nahyan.

Kanad Hospital is a not-for-profit hospital that strives to diligently follow the teachings of Jesus in the way that we care for women, children, and their families. We have the privilege of being the first hospital established in the Abu Dhabi Emirate and the first private hospital in the Emirate to attain JCI accreditation. Additionally, we are the first hospital in the world to obtain JCI Clinical Care Program Certifications for our treatment program for Respiratory Distress Syndrome in newborns and for our Natural Birth after Cesarean Section program for mothers.

Hope: Healthy communities transformed by the love of the God. Purpose: To honor God by providing exceptional whole person healthcare to the community with the love and compassion of Jesus Christ.

Position Summary: 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-9-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 24-48 hrs upon receiving the request from physician for approval.