Officer - Medical Authorization

Transguard Group was established in 2001 and has diversified significantly, we lead in the fields of Cash Services, Security Services, Manpower Services, Facilities Management & Aviation. Transguard Group is the UAE’s most trusted business support and outsourcing provider and has a large, dynamic and culturally diverse workforce with 50,000 employees! We are currently recruiting for an Officer - Medical Authorization for our trusted client to be based out of their office in Abu Dhabi

Purpose-

The job holder is responsible for all aspects of the prior authorization process including collecting all the necessary documentation, contacting the customer/network provider for additional information and completion of the required prior authorization in order to proceed with service request. This job also requires ensuring complete, timely, and accurate identification and submission of prior and retro authorization requests.

Responsibilities-

• 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.
• Verifies the requests with insurance policy; interpret medical information such as diseases or symptoms, and diagnostic descriptions and recommended procedures for treatment and determine if requested procedures are justified.
• Liaises with Supervisors, Officers and Medical Coding Coordinator to evaluate medical record documentations 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.
• Compliance with HAAD/ DHA regulations.
• Compliance with set medical coding standards.
• Approves medical authorization requests (as per delegated authority) if they comply with all stipulations and forward them to the Supervisors for final approval. Forward approved medical authorization requests to the provider and ensure proper record keeping.
• Handles all calls from Pharmacies or follow up calls on medical   authorization. Support clients/providers on any medical authorization related queries, follow ups, emails or fax.
• Coordinates with Doctors/Providers on medical authorization procedure requests if they are not acceptable and recommend appropriate alternate approaches. Recommend rejection of request for the manager to approve along with justifications.
• Reviews periodically medical claims policies and procedures, identify operational gaps and propose recommendations and solutions to address these gaps in order to keep pace with the growth of the organization.
• Provides Management with appropriate reports regarding the unit and compliance with operational policy and procedures.