Specialist,DRG Case Management

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.