Overall Job Summary
Responsible for processing different specific tasks involve in the daily insurance process involving authorization. Submission, resubmission and corporate claims.
As per contract
- Professionally Responsible To
Head of Department
- Reports To
Head of Department
- 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.
- Degree in Accounting, Business Administration or equivalent.
- 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.
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.