Job Description

About Metabolic.Health

Metabolic.Health is an integrated metabolic care provider in the UAE. The organization combines clinical care, diagnostics, and data driven models to improve outcomes in diabetes and metabolic health.

Role Overview

The Insurance Coordinator – OP Approvals manages outpatient insurance approvals and authorization workflows. You ensure timely approvals, accurate documentation, and compliance with payer rules. You protect revenue by preventing authorization denials and treatment delays.

Key Objectives

Operational Control

• Ensure all outpatient services receive approvals before treatment
• Maintain zero tolerance for unauthorized services
  

Performance Metrics

• Achieve approval turnaround within payer SLA timelines
• Maintain less than 3 percent denial rate due to authorization errors
  

Compliance

• Ensure adherence to DHA regulations and payer policies
• Maintain complete audit ready authorization records
  

Core Responsibilities

Authorization Management

• Verify insurance eligibility and benefits before initiating approval requests
• Submit pre authorization requests with complete clinical documentation
• Track approvals, extensions, and validity periods to prevent service disruptions
• Escalate urgent or delayed approvals to payers and internal leadership
  

Documentation Integrity

• Ensure physician orders, clinical notes, and diagnostic reports support medical necessity
• Validate CPT and ICD coding alignment with requested services
• Maintain organized digital records of approvals, correspondence, and payer responses
  

Payer Coordination

• Liaise with insurance companies and TPAs to expedite approvals
• Communicate approval status to front office, clinical teams, and patients
• Clarify payer requirements and disseminate updates to relevant teams
  

Denial Prevention and Resolution

• Investigate approval denials and implement corrective actions
• Identify trends in authorization rejections and recommend process improvements
• Support resubmissions and appeals with enhanced documentation
  

Systems and Reporting

• Manage authorization workflows within HIS and payer portals such as EclaimLink
• Generate daily and monthly reports on approval volumes, turnaround times, and denial trends
• Recommend automation opportunities to improve efficiency and tracking
  

Requirements

• Certified Professional Coder credential
• Bachelor’s degree in Health Information Management, Nursing, or related field
• Strong knowledge of DHA regulations and UAE payer rules
• Minimum 2 years of coding and denial management experience in the UAE
• Proficiency in EHR systems, coding tools, and Microsoft Office
• Strong analytical skills and attention to detail
• Effective communication with clinical, billing, and insurance teams
• Experience in outpatient clinics or specialty centers, preferably endocrinology or metabolic care