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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing inpatient precertification cases, including clinical file reviews, coding compliance, and utilization reviews while adhering to departmental goals and regulatory standards. Proficient in stakeholder management and effective communication within a 24/7 healthcare environment.
Highest-signal resume keywords
Inpatient Precertification ManagementCPT/ICD Coding ReviewUtilization ReviewMedical Practical ExperienceCertified Medical Coder
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical File ReviewDRG Severity of Illness AnalysisUtilization ReviewCPT CodingICD CodingData AnalyticsMachine LearningAI ToolsCost-Containment ProtocolsMedical Documentation Request
Soft Skills
Strong English CommunicationInterpersonal SkillsStakeholder Management
Tools & Technologies
MS OfficeCloud-Based ToolsData Governance Tools
Certifications & Qualifications
Bachelor’s of Medicine/Surgery MBBSCertified Medical Coder
Industry Keywords
UAE Insurance Regulator RequirementsAbu Dhabi Market KnowledgeAl-Ain Market Knowledge
Tech Stack
Tools & technologiesCloud
About the role
Key responsibilities & impact- Manage Inpatient Precertification cases while meeting departmental goals, activity timelines, and compliance measures
- Work flexible shifts according to the Team Leader’s schedule in a 24/7 precertification team
- Adjudicate inpatient precertification cases and authorize decisions within stipulated turnaround times
- Perform complete file reviews of clinical and billing documentation
- Request missing medical documentation essential for decision-making
- Review DRG Severity of Illness and CPT/ICD coding, discussing issues with treating doctors and medical coders when required
- Perform utilization reviews for DRG and FFS cases, including final bills, consumable markups, non-covered items/services, and overutilization
- Review claims according to CPT and ICD coding guidelines and UAE insurance regulator requirements
- Adhere to cost-containment protocols
- Refer cases for second opinions and lower-cost network facilities or home-country treatment when necessary
- Use AI, machine learning, data, analytics, and cloud-based tools responsibly in accordance with data governance, security, and ethical-use standards
Requirements
What you’ll need- Bachelor’s of Medicine/ Surgery MBBS is a must
- 1-3 years of Medical Practical Experience
- Physically fit to carry out duties
- Certified Medical Coder [Preferable]
- Legally permitted to work in the country of operations
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
- Strong English communication skills, both verbal and written
- Excellent interpersonal and stakeholder management abilities
- Abu Dhabi and Al-Ain Market knowledge
- Notice period maximum to be 1 Month
Benefits
Comp & perks- Permanent employment
- Flexible shift basis for a 24/7 precertification team
- Inclusive workplace and equal-opportunity employment environment
- AI, business intelligence, data analytics, and emerging technology environment
- Information security and data governance practices