Senior Authorization Officer

Sheikh Shakhbout Medical City

Abu Dhabi Healthcare Company (SEHA) is the largest and most comprehensive healthcare network in the UAE that was established in 2007 with the objective of operating all public hospitals and clinics across the Emirate of Abu Dhabi.

SEHA is committed to delivering world-class healthcare services using the most advanced diagnostics and systems across its network of public healthcare centers and hospitals in addition to partnering with global leaders in healthcare, including world renowned organizations such as the Mayo Clinic.

Authorization, Verification & Eligibility

• Serve as the primary resource for SEHA Business Entity reading of prior authorization process and requirements;
• Collect clinical information regarding services to be rendered;
• Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information;
• Updates systems with accurate information obtained;
• Responsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel;
• Works with inpatient accounts for authorization and held responsible for timely notification to payers of the patient s admission to the facility to protect financial standing;
• Uses utmost caution that obtained benefits, authorizations, and pre-certifications are accurate according to the actual test and procedure or registration being performed;
• Ensures all benefits, authorizations, pre-certifications, and financial obligations of patients, are documented on account memos, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts;
• May contact physicians, Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned;
• Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related Pre-Access account issues, within defined time frames;
• Contact the payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization;
• Provide standardized documentation within the system to identify prior authorization and the criteria surrounding such authorization;
• Stay informed and research information regarding insurance criteria for prior authorization;
• Serve as the primary resource to patients regarding the prior authorization process