Approval Officer

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Approval Officer at NMC Healthcare is a full-time onsite role in Dubai focused on managing rejected pre-authorizations, obtaining physician justification, and resending to insurers for approval, while ensuring requests meet regulators’ standards and claim adjudication rules. Key duties include verifying insurance eligibility, communicating payer information, processing authorizations and referrals, reviewing medical history, notifying staff of approvals, updating data, and guiding clinicians to use correct ICD CPT CDT codes to avoid rejections. Requirements: college diploma, proficiency in ICD CPT DRG HCPCS, and 2+ years in insurance claims or pre-authorization. For applicants: tailor your resume to show concrete wins in approvals, payer liaison, data accuracy, regulatory compliance; include metrics like turnaround time, rejection reduction, and on-site Dubai availability; craft a focused cover letter linking your experience to the role.

Handling the rejected pre-authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.

Ensure that the details of the Pre-Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules

• Verifies customers' insurance eligibility and authorization in a timely and accurate manner

• Communicates payer authorization and eligibility information.

• Sends payer informational correspondence.

• Complete service and procedure authorizations and referrals

• Review the patient's medical history and insurance coverage for approval.

•  If necessary, contact referral physicians for more information.

• Once approval is obtained, the concerned staff and treating physicians should be notified.

• Enter new patient information and update data in our system.

• As needed, assist with other clerical responsibilities.

• Notifies branch management of concerns with payer coverage or other service noncoverage.

• Keep track of the daily production report.

• Keep the pending approval monitoring system updated for the next day's follow-up.

• The supervisor and team leader will monitor the schedules and emergency requirements and all the quires from the facility.

• Guide the doctors and concerned staff to follow the correct ICD, CDT and CPT codesto avoid the rejection

• College Diploma - Any discipline or related fields. 

• Proficiency in medical coding standards: ICD, CPT, DRG, HCPCS

Experience in insurance claims management or pre-authorization (approval) processes, typically 2+ years