Executive

Description

Job Title

Executive

Location

AE

Organization Name

OIC Preauthorization

Department Description

Brief Description

Detailed Description

Job Purpose

The jobholder will be responsible for managing inpatient cases as per defined TAT and ensuring accuracy of DRG codes submitted by Healthcare Providers.Jobholder must possess ability to deliver in a metric driven high pressure environment which functions in real time.Strong attention to detail; high degree of speed and adjudication accuracy.Strong proficiency in handling computer and software skills.

Job Requirements

Job Responsibilities

Visit providers to manage inpatient cases, review DRG codes/severity levels submitted by healthcare facilities. Coordinate with physicians/providers efficiently& 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. Ensure all regulatory guidelines issued by the various regulatory bodies are adhered within day to day operations. Meet DRG Case Management defined targets; Meet 100% of assigned onsite visits to identify medical negligence, compromised member care and wastage . 100% compliance of ePAR process and guidelines. Ensure closure of case visit findings and accurate adjudication of ePAR cases. Prepare analytical reports of DRG cases and billing on a monthly basis.

Additional Details

Additional Skills

Excellent coding skills; minimum five years of coding and IR-DRG and AP DRG 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). Any Certifications in Medical Coding will be a key advantage. Ability to work under pressure and multitask in a highly dynamic environment. Good communication, negotiation, presentation and interpersonal skills.

How To Apply

Amount of Travel

Work At Home

Skills

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