Pre-Approval Officer

About Al-Futtaim Group and Healthcare Division

Founded in the 1930s as a trading venture, Al-Futtaim Group has evolved into a highly diversified and forward-thinking private company headquartered in Dubai, UAE. It operates across five main sectors: automotive, financial services, real estate, retail, and healthcare, employing over 35,000 individuals in more than 20 countries throughout the Middle East, Asia, and Africa. Partnering with over 200 globally recognized and innovative brands, Al-Futtaim thrives on entrepreneurial spirit and unwavering dedication to customer satisfaction, enabling continuous growth by adapting to the evolving needs of the communities served.

Within the healthcare arm, HealthHub Clinics by Al-Futtaim offers a comprehensive multi-speciality medical service with more than 20 clinics across Dubai, delivering over 25 specialties. Committed to excellence, these clinics integrate advanced diagnostics, trusted medical expertise, and specialized services, all aligned with international quality standards, demonstrated by the prestigious Gold Seal accreditation from Accreditation Canada.

Role Purpose and Responsibilities

• Thoroughly evaluate all claim forms assigned on the dashboard, providing timely and detailed feedback.
• Maintain 100% accuracy in updating approvals received from insurance companies.
• Coordinate with various departments to request any missing documents or additional information needed.
• Consistently achieve daily claims verification productivity targets.
• Execute detailed quantitative analyses, ensuring all documented components—patient identity, signatures, dates, and related medical reports—are complete and accurate for services rendered.
• Adhere strictly to coding protocols and legal guidelines to guarantee regulatory compliance.
• Perform qualitative reviews to assess documentation adequacy and consistency, ensuring diagnoses precisely mirror the provided care and treatment, and verifying compliance with third-party reimbursement policies and special screening standards.
• Receive daily patient medical records, identify documentation deficiencies, notify relevant staff, and forward such records to physicians.
• Ensure completion and correction of documented deficiencies within the established standards prior to submission.
• Submit all pre-approvals punctually in line with established KPIs, emphasizing quality to secure approvals on the first submission attempt.
• Mitigate revenue loss by vigilantly monitoring and coordinating with coding teams and physicians to address insurance claim rejections.
• Track approval behaviors of various payors and corporate clients to customize actions for timely pre-approval acquisition.
• Guarantee submission of all eligible inpatient, outpatient, and pharmacy pre-approvals to insurance companies or third-party administrators.
• Follow up internally to supply additional information requested by insurance providers.
• Engage with physicians to provide clinical justifications necessary for pre-approvals.
• Collaborate closely with the team on complex cases to accelerate payer approvals.
• Ensure PAR (Pre-Authorization Request) submissions comply with insurance industry and Dubai Health Authority regulations.
• Maintain strict adherence to pre-approval KPIs, documenting performance as required.
• Educate billing and approval teams to refine and enhance workflow processes.
• Meet turnaround targets without compromising quality or productivity.
• Coordinate with the Clinical Documentation Improvement (CDI) team to educate physicians and paramedical staff on proper documentation for claims.
• Accurately maintain monthly claims submission data for each insurance company.
• Work collaboratively with stakeholders to enhance overall efficiency of submission processes.
• Analyze financial data related to the revenue cycle to identify defaulting payors and partner with relevant departments to develop remedial strategies mitigating financial risks.

Required Skills and Experience

• A solid medical background enabling proficient management of claim reconciliation.
• Proven negotiation capabilities.
• Excellent interpersonal and communication skills.
• At least 3 years of experience in a comparable role.
• Certification in professional medical coding from an accredited institution is mandatory.

Team and Reporting

The position reports directly to the Revenue Cycle Manager. The incumbent serves as a vital link between the revenue cycle department and clinical staff, ensuring effective communication and smooth processing of claims and approvals.