Job Description

KEY RESPONSIBILITIES AND DUTIES:

• Reviews and processes pre-authorization requests from healthcare providers (hospitals, laboratories, pharmacies) to determine if services are covered.
• Verifies patient details and insurance eligibility for all pre-authorization requests.
• Communicates approval or rejection decisions to healthcare providers and patients based on pre-established criteria.
• Reviews medical documentation submitted with pre-authorization requests to confirm the medical necessity and compliance with insurance policies.
• Maintains accurate records of all processed pre-authorization requests and ensures proper documentation for audits.
• Resolves issues with incomplete or incorrect information related to pre-authorization requests.
• Works closely with the claims and billing departments to ensure that pre-authorization approvals are aligned with the submission of insurance claims.
• Responds to inquiries from patients, providers, and internal stakeholders regarding the status of pre-authorization requests.

Additional Requirements

• Candidates MUST have proven clinical experience in Pre-Authorization, Insurance Verifcation or a related field in a healthcare setting for 2 -3 years.
• Bachelor’s degree in a relevant field healthcare, business administration, or equivalent
• 2-3 years hospital/clinic experience in GCC
• Arabic Speaker will be an advantage