Job Description

We’re Hiring at Sukoon Insurance!
Role: Specialist,DRG Case Management
Department: Life and Medical Claims

Medical Pre-authorization Team is looking for a dedicated DRG Inpatient Pre-authorization Specialist to join us in strengthening our approvals and drive case management.

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 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 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.

Qualifications:
Bachelor’s degree in medicine is mandatory.
Globally recognized qualification in coding skill.
Insurance qualification/background is essential in similar role.
Minimum working experience of 1-2 years in UAE in similar role.
Candidate must have good exposure to IP case preapproval protocols.
Candidate must possess and be well versed with regulatory guidelines.