Officer - Medical Authorization

Transguard Workforce Solutions is the UAE’s leading provider of unique and innovative HR solutions. With a decade of experience in the region and a team that possesses extensive knowledge of the market, we provide a fully integrated HR solution.

We are recruiting a Officer - Medical Authorization for our client, based out of their Abu-Dhabi office.

Key Responsibilities:

1. Policies, Processes and Procedures: Follows the departmental adherence to all relevant policies, processes, standard operating procedures and instructions so that work is carried out in a controlled and consistent manner.
2. Medical Authorization Activities: Verifies the requests with insurance policy; interprets medical information such as diseases or symptoms, and diagnostic descriptions and recommended procedures for treatment to determine if requested procedures are justified.
3. Liaises: Works with Supervisors, Officers, and Medical Coding Coordinator to evaluate medical record documentation to ensure that diagnostic and recommended procedural codes accurately reflect and support the treatment of the disease or symptom, and to ensure that data comply with legal standards and guidelines.
4. Approvals: Approves medical authorization requests (as per delegated authority) if they comply with all stipulations and forwards them to the Supervisors for final approval. Forwards approved medical authorization requests to the provider and ensures proper record keeping.
5. Client Support: Handles all calls from Pharmacies or follow-up calls on medical authorization. Supports clients/providers on any medical authorization-related queries, follow-ups, emails, or faxes.
6. Rejection of Claims: Coordinates with Doctors/Providers on medical authorization procedure requests if they are not acceptable and recommends appropriate alternate approaches. Recommends rejection of requests for the manager to approve along with justifications.
7. Continuous Improvement: Reviews periodically medical claims policies and procedures, identifies operational gaps, and proposes recommendations and solutions to address these gaps in order to keep pace with the growth of the organization.
8. Reports: Provides Management with appropriate reports regarding the unit and compliance with operational policy and procedures.