Preauthorization Administration

JOB SUMMARY

The Pre-authorization Administrator is a member of the Patient Financial Services Department. This position is responsible for reviewing and validating insurance eligibility and coordination of prior authorization pre-certifications authorization coordination of benefits and ongoing communications with insurance companies

KEY ROLE ACCOUNTABILITIES

• Verifies accurate patient demographics insurance coverage eligibility and member benefits prior to service delivery.
• Reviews submit and track preauthorization requests through insurance portals and electronic billing systems ensuring all documentation is complete and accurate.
• Liaises with health insurance companies third-party administrators healthcare providers and clinical teams to clarify and obtain necessary documentation to demonstrate medical necessity.
• Identifies reasons for preauthorization denials or delays coordinate with relevant teams for justifications or resubmissions and follow up promptly with insurance providers.
• Serves as a primary point of contact between insurance companies patients and internal staff to resolve issues and maintain positive working relationships.
• Maintains up-to-date knowledge of insurance company guidelines provider policies and payer updates to ensure compliance and efficient processing.
• Document all actions communications and updates related to preauthorization requests accurately in the system maintaining proper logs and records.
• Prepares reports on authorization trends denials and turnaround times for management review and continuous improvement.
• Covers on-call shifts according to the monthly schedule and adhere to hospital policies and procedures.
• Maintains confidentiality of patient and clinical information in compliance with internal standards and legal requirements.
• Perform other related duties as assigned
• Adheres to standards as they appear in the Code of Conduct and Conflict of Interest policies
• Adheres to and promotes Values

In view of the evolving needs and opportunities within this position may be required to perform other duties as assigned and reporting relationships may vary.

WORK ENVIRONMENT THE ROLE OPERATES IN

• Work is normally performed in an office environment
• No or very limited physical effort is required
• No or very little exposure to physical risk

ORGANIZATION VALUES

• Trust: Being competent; acting consistently reliably and predictably; acting with honesty and integrity; respecting patient employee and commercial confidentiality; delivering on commitments

• Care: Acting with empathy kindness and compassion; being humble; listening and responding; acting with cultural sensitivity; Caring for patients and staff

• Teamwork: Sharing information and knowledge and learning from demonstrated expertise; being respectful and thereby earning respect of others; acting with professionalism; leading and following; collaborating and being accessible

• Transparency: Frequent and honest communication; open access to information for decision making; willingly acknowledge shortcomings; speaking up about concerns; publishing performance indicators

• Innovation: Freedom to innovate; welcoming ideas and encouraging creativity; supporting talent; creating confidence; celebrating successes

• Efficiency: Providing measurable value; using data to drive decision making; having and achieving clear goals; building processes that work; continuously improving outcomes in patient and family care

QUALIFICATIONS EXPERIENCE AND SKILLS – SELECTION CRITERIA

ESSENTIAL

PREFERRED

Education

Bachelor’s degree in commerce or Health-related field or relevant discipline

Master’s Degree in Commerce or Health related field or relevant discipline

Experience

2 years’ experience in a related role in a healthcare facility or health insurance company

• Working experience with Cerner RCM
• Experience working with Cerner Revenue Cycle Management (RCM) system.
• Experience working with healthcare providers or insurance companies locally or within the GCC region.

Certification and Licensure

Medical billing and coding certificate or other relevant Revenue Cycle certification is preferred.

Professional Membership

Job Specific Skills and Abilities

• Proven experience in prior authorization or benefits management.
• Strong knowledge of medical insurance coverage policies and clinical guidelines.
• Ability to understand and interpret medical terminology accurately.
• Excellent organizational and time management skills with keen attention to detail.
• Demonstrated flexibility and responsiveness to changing workloads and priorities.
• Exceptional customer service skills with the ability to communicate effectively and tactfully especially in stressful situations.
• Excellent interpersonal and communication skills both written and verbal.
• Proficiency in Microsoft Office Suite and relevant electronic billing/insurance portals.
• Fluency in written and spoken English and Arabic

Fluency in other languages