Junior RCM Officer ( Pre Authorization )

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