Approval Officer NMC healthcare LLC

Job Description

The Approval Officer is responsible for evaluating and processing insurance claims, ensuring compliance with medical and regulatory standards, and facilitating approvals for medical procedures or treatments in a timely manner.

Responsibilities

Key Responsibilities

Corresponding Key Activities performed by the role

Managerial

Technical

• Review and verify insurance coverage and eligibility for medical services.

  • Process pre-authorization requests for medical procedures, diagnostic tests, and medications.

  • Ensure all documentation complies with insurance policies and regulatory requirements.

  • Coordinate with medical staff to obtain necessary clinical justifications for approvals.

  • Communicate with insurance companies to resolve discrepancies and expedite approvals.

  • Maintain accurate records of all approvals and denials in the hospital's system.

  • Respond promptly to inquiries from patients, staff, and insurance providers.

  
  

Quality and Safety

• Promoting and maintaining quality in all services and ensure continuous quality improvement measures are in place. Conduct method evaluation/ development as per standard policies and procedures

  • Complying with all safety and quality control programs and procedures as applicable

  • Complying with applicable precautions for environmental safety, infection control, using a series of interventions that minimize or prevent cross infections

  • Ensuring that safety procedures and quality assurance tests are maintained within all sections

  • Comply and support clinical audit processes within the service and report on these as agreed 

  • Communicating in a professional and courteous manner with patients, family and other medical personnel as necessary to obtain information for laboratory records, explain procedures, clarify orders and communicate status.   

Continuous Education

• Participating in education sessions for department staff, doctors and nurses on the safe and secure handling of equipment, i.e teaching, induction, peer review, case studies, and clinical presentations

  • Participating in department programs/ committees, various hospital committees, and staff meeting (when requested) 

  • Participating in the orientation and training of new employees

  • Maintaining professional knowledge by attending lectures, seminars or on-line education sessions

  • Completing and maintaining all regulatory requirements including licensure and certification and other mandatory training within established time frames.

  • The ability to apply technical skills, together with a demonstrable knowledge of and interest in sciences, such as anatomy, physiology and physics;

Occupational Safety and Health Management Systems 

• Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements

  • Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports

  • Attend applicable OSH/Infection control training programs, mock drills and awareness programs

  • Comply with reasonable OSH instructions, policies and safe working procedures 

  • Use of appropriate personal protective equipment and safety systems. 

  •  Be familiar with emergency and evacuation procedures 

  •  Not wilfully or recklessly endanger anyone’s health and safety 

  • Comply with Waste management procedures and policies. Reduce, Reuse, Recycling of waste as much as possible 

  • Attend all OSH Trainings, awareness programs and mock drills. 

  • Participates in the OSHMS audits, inspections, ensuring standards are maintained

Prevention and Control of Infection (PCI): 

• PCI is everyone’s responsibility. All staff are required to read and implement the NMC PCI Policy and Strategy in an effort to maintain the highest possible standards of cleanliness at all times, thus reducing the risk of infection in patients, staff and visitors. 

  • The strictest hand hygiene, 5 moments of hand hygiene, bare below the elbows and environmental care, will be expected of all staff, including the post holder, at all times