Pre-Approval Officer
About Al-Futtaim Group
Established in the 1930s as a trading business, Al-Futtaim Group today is one of the most diversified and progressive, privately held regional businesses headquartered in Dubai, United Arab Emirates. Structured into five operating divisions: automotive, financial services, real estate, retail, and healthcare; employing more than 35,000 employees across more than 20 countries in the Middle East, Asia, and Africa, Al-Futtaim Group partners with over 200 of the world's most admired and innovative brands. Al-Futtaim Group’s entrepreneurship and relentless customer focus enables the organization to continue to grow and expand, responding to the changing needs of our customers within the societies in which we operate.
By upholding our values of respect, excellence, collaboration, and integrity, Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day.
What you will do
Review all claim forms assigned on the dashboard and provide adequate feedback on the same.
Update approvals received from insurance companies with 100% accuracy.
Communicate with departments in case of any missing documents or if more information is required.
Meet daily claims verification productivity.
Perform quantitative analysis – conduct a comprehensive review of the record to assure the presence of all component parts such as patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports indicated by the nature of the treatment rendered.
Follow coding guidelines and legal requirements to ensure compliance with regulatory guidelines.
Perform qualitative analysis – evaluate the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review the records for compliance with established third-party reimbursement agencies and special screening criteria.
Receive the patient medical record daily and check for any deficiency in documentation; if any, notify the concerned staff and send it to the physician.
Receive the completed records and ensure that the marked deficiencies are cleared and follow the standards.
Ensure timely submissions of all pre-approvals as per KPIs.
Improve the quality of pre-approval submissions to obtain approval from the first round.
Stop revenue loss through monitoring and coordination with all concerned stakeholders like the coding team and physicians to revise insurance company rejections.
Monitor behavioral approval processes of various payors and corporates to apply customized actions to obtain pre-approvals.
Ensure all pre-approvals are submitted for all eligible inpatient, outpatient, and pharmacy cases to insurance companies or third-party administrators.
Follow up internally for additional information required by insurance companies.
Interact with physicians for the clinical justification of the pre-approvals.
Work closely with the team on complex cases to obtain faster approval from payers.
Ensure that PAR submissions are dealt with according to insurance industry and DHA regulations.
Comply with pre-approval KPIs (Key Performance Indicators) and maintain a record of pre-approval KPIs as and when required.
Educate billing and approval teams to enhance the process flow.
Ensure that targets are met within turnaround time while maintaining quality and productivity.
Coordinate with the CDI team to educate physicians and other paramedical staff to ensure proper claims documentation.
Maintain accurate monthly data of claims submissions for each insurance company.
Coordinate with other business stakeholders to improve overall submission process efficiency.
Analyze financial data related to the revenue cycle to identify defaulting payors and work with the concerned department on corrective strategies to mitigate financial risks.
Required skills to be successful
Strong medical background to handle reconciliation efficiently.
Strong negotiation skills.
Strong soft skills.
About the team
The role will report to the Revenue Cycle Manager. The pre-approval specialist will assist in the review and update of claims and approvals received from the insurance companies, serving as a point of contact between the revenue cycle department and the medical staff in the clinics.
What equips you for the role
Minimum 3+ years’ experience in a similar role.
Certified professional coding certificate from a reputed institution.
About Al-Futtaim Healthcare
We hear your ambition.
For over 90 years, the Al-Futtaim Group has been bringing the world’s leading brands of lifestyle watches, cars, home furnishings, and fashion to the UAE. The Group has now introduced a whole new way of holistic healthcare through HealthHub Clinics by Al-Futtaim, its multi-speciality chain of more than 20 clinics in Dubai with over 25 specialties offering the right combination of advanced diagnostics, proven medical expertise, and specialised services.
What gives our clinics an edge is that as a part of the Al-Futtaim Group, you can expect world-class quality standards, with access to the best medical services and facilities within a healing environment. It’s a new way of healthcare that’s designed to meet a patient’s needs with a complete range of smart healthcare solutions. As testimony to this, only recently, we’ve earned a rare milestone of being the only primary healthcare network in the UAE to receive the Gold Seal by a reputed international body: Accreditation Canada.
As trusted partners to health, we at HealthHub Clinics adopt evidence-based learning that enables us to listen to our patients more carefully. It helps us in treating the cause and not just the symptoms, while applying global best practices to ensure quality of care for every family member. Most of all, we adopt a patient-centric approach to healthcare that is reflected in the promise of our core belief: “We Hear You.”