Insurance Coordinator - OP Approvals

Role OverviewThe 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 ObjectivesOperational ControlEnsure all outpatient services receive approvals before treatmentMaintain zero tolerance for unauthorized servicesPerformance MetricsAchieve approval turnaround within payer SLA timelinesMaintain less than 3 percent denial rate due to authorization errorsComplianceEnsure adherence to DHA regulations and payer policiesMaintain complete audit ready authorization recordsCore ResponsibilitiesAuthorization ManagementVerify insurance eligibility and benefits before initiating approval requestsSubmit pre authorization requests with complete clinical documentationTrack approvals, extensions, and validity periods to prevent service disruptionsEscalate urgent or delayed approvals to payers and internal leadershipDocumentation IntegrityEnsure physician orders, clinical notes, and diagnostic reports support medical necessityValidate CPT and ICD coding alignment with requested servicesMaintain organized digital records of approvals, correspondence, and payer responsesPayer CoordinationLiaise with insurance companies and TPAs to expedite approvalsCommunicate approval status to front office, clinical teams, and patientsClarify payer requirements and disseminate updates to relevant teamsDenial Prevention and ResolutionInvestigate approval denials and implement corrective actionsIdentify trends in authorization rejections and recommend process improvementsSupport resubmissions and appeals with enhanced documentationSystems and ReportingManage authorization workflows within HIS and payer portals such as EclaimLinkGenerate daily and monthly reports on approval volumes, turnaround times, and denial trendsRecommend automation opportunities to improve efficiency and trackingUnderstand, follow and support all hospital infection control programs.RequirementsBachelor's degree in healthcare administration, business administration, or a related field is preferred.Certified Professional Coder (CPC) CertifiedStrong understanding of DHA regulations and UAE payer requirementsProficiency in EHR systems, payer portals, and Microsoft Office toolsMinimum 2 years in insurance approvals or revenue cycle operations in the UAEStrong attention to detail and problem solving abilityEffective communication with clinical and insurance stakeholdersExperience in outpatient clinics or specialty centers, preferably endocrinology or metabolic care.Language: Fluency in English is required. Proficiency in Arabic is an advantage.#J-18808-Ljbffr