Insurance Officer - UAE National

Overall Job Summary

Responsible for processing different specific tasks involve in the daily insurance process involving authorization. Submission, resubmission and corporate claims.

  • Hours
    As per contract
  • Professionally Responsible To
    Head of Department
  • Reports To
    Head of Department

Main Responsibilities

  • Responsible specific insurance processes with regards to service pre-authorization, submission and resubmission.
  • Update the clinics for the current pre-authorization request status to facilitate scheduling of approved services and denied request and claims for possible revision, justification or acceptance of denial.
  • Develop and maintain relationships with insurance carriers to keep the department up to date with all billing and processing requirements from outside payers.
  • Coordinate discussions between billing clerks and utilization nurses for insurance claims process.
  • Provide necessary claim reports for analysis and performance output measurement
  • Analyze recommend claim adjustments, bad debt provision, and contractual allowances.
  • Create and provide a collection area for collecting balances not received in the ordinary revenue cycle process.
  • Respond accordingly to insurance related queries for both internal and external customers.
  • Provide explanations and/or guidance on insurance coverage.
  • Identify and resolve patient insurance queries and complaints.
  • Pro-actively participate in collaboration with the Line Manager to meet the strategic and operational business goals.
  • Partner with the HOD to ensure the department budgets and KPIs are met.
  • Work towards meeting departmental strategies and KPIs and display a shared commitment towards contributing to the Hospital’s mission and vision
  • Adhere to the department and Healthpoint policies and procedures in alignment towards the regulatory and accreditation requirements.
  • Participate in regular departmental meetings
  • Timely complete the entire performance evaluation cycles.
  • Contribute towards a disciplined culture of continuous improvement resulting in enhanced coordination of work activities and improved efficiency.
  • Drive an appropriate level of self-continuous personal and professional development
  • Promote effective communication strategies and maintain good interdepartmental liaison.
  • Participate in Departmental Quality Improvement activities
  • Ensure providing services that are in compliance with all applicable standards and requirements of Joint Commission International (JCI), Legislation, Policies, Quality Standards, DOH, and all other applicable regulatory bodies.
  • Maintain professionalism and confidentiality at all times
  • Communicate in a culturally sensitive manner with patient and family using appropriate terminologies in patient interactions.

Education

  • Degree in Accounting, Business Administration or equivalent.

Experience

  • Al least 2 years of relevant experience within finance environment.
  • Familiar with UAE Insurance practices will be an added advantage.

Specific Skills and Abilities

  • Proven computer skills in MS Excel, Word, Access
  • Demonstrate teamwork, attention to details and organized.
  • Must be familiar with the revenue cycle management within healthcare environment.
  • Must be familiar with basic medical coding and third party operating procedures and practices.

Behavioral Competencies

Communicates with purpose - Conveys ideas and information to groups for mutual understanding, commitment and action.

Accountability - Accepts responsibility for one's actions regardless of outcomes.

Relationships - Creates and maintains partnerships based on mutual trust, respect, shared responsibility and purpose.

Improve Recommends and Implements changes to better the enterprise and position IHN as the recognized leader in all healthcare specialties.

Nurture & Develop - Seeks & supports development opportunities for self & others, in order to fulfill current or future responsibilities more effectively.

Go Beyond Patient Expectations - Leverages skills, caregivers, financial & business information to exceed patient expectations.