Manager, Preauthorization

  • Healthcare Manager Jobs
  • Other , Other
  • 1 week ago
  • 0
  • Healthcare Manager Jobs
  • relevant qualification
  • Relevant experience

Description

Job Description

Key Accountabilities:

  • The job holder will be responsible for managing day-today activities of pre-approval function including processing of pre-approval requests.
  • The employee would be responsible for monitoring, maintaining, and improving transactional quality of the activities within the team and driving standards.
  • Ensure all pre-approval requests are processed with 100% accuracy and in accordance with regulatory/clinical guidelines.
  • Ensure implementation of all regulatory advisories and protocols. Optimization of the productivity of the team through operational efficiency.
  • Providing constant and structured feedback to the Clinical Governance and Provider Management team to take corrective steps.
  • Continuous improvement of processes, identify areas of opportunities and suggest improvement.
  • To provide guidance, training and regular performance reviews/feedback to the team based on findings. Maintaining superior member experience, timely redressal of grievances.
  • Managing daily operational activities of medical call center. Ability to attend calls of providers/members/partners.

Job Requirements:

  • Timely processing of pre-approval cases; manage out/inpatient cases (inflow/outflow).
  • Coordinate with providers for case management.
  • Prudent adjudication of PBM approvals.
  • Ensure effective communication with provider.
  • Negotiate cost with providers, ensure correct length of stay of inpatient cases and effective implementation of insurance protocol/DRG billing.
  • Coach pre-approval staffs and ensure all regulatory guidelines issued by the various regulatory bodies are adhered within day-to-day operations.
  • Analyze data, prepare and present analytical report to management. 100% compliance of ePAR process and guidelines.
  • 100% adherence of pre-approval TAT and authority matrix. Visit providers to manage inpatient cases, review DRG codes/severity levels submitted by healthcare facilities.
  • Coordinate with physicians/providers efficiently and understand complete progress during patient’s hospitalization.

Job Qualifications:

  • Jobholder must be energetic and possess ability to learn quickly in fast paced environment.
  • Strong attention to detail; high degree of speed and accuracy.
  • Strong proficiency in handling computer and software skills.
  • A graduate of MBBS
  • At least 5 years of relative work experience
  • Knowledge of MS Office especially in MS-Excel
  • Knowledge of the full know-how of UAE insurance industry and regulatory environment
  • Interpersonal and influencing skills
  • Problem solving and decision-making capabilities
  • Good command over English (Written, Spoken & Reading)
  • Ability to work under pressure and to do multi-tasking
  • Good communication, negotiation, presentation, and interpersonal skills

Conditions

Languages