Job Description

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.

Understand, follow and support all hospital infection control programs

Requirements

• Bachelor's degree in healthcare administration, business administration, or a related field is preferred.
• Certified Professional Coder (CPC) Certified
• Strong understanding of DHA regulations and UAE payer requirements.
• Proficiency in EHR systems, payer portals, and Microsoft Office tools.
• Minimum 2 years in insurance approvals or revenue cycle operations in the UAE.
• Strong attention to detail and problem solving ability.
• Effective communication with clinical and insurance stakeholders.
• Experience in outpatient clinics or specialty centers, preferably endocrinology or metabolic care.
• Language: Fluency in English is required. Proficiency in Arabic is an advantage.