Job Description

• Obtain and process prior authorizations through established protocols, policies, and procedures.
• Monitoring and follow-up on prior E- authorization for services.
• Claim processing, submission, re-submission, recoveries, and reconciliation
• E-Claims analysis prior to their submission.
• Manage medical coding, diagnoses, and procedures as per the coding protocol.
• Reviews claims to make sure that billing requirements are met.
• E-Reconciliation of claims paid and outstanding with insurance companies and coordination with the Finance department.
• Manage the complete revenue cycle of the organization.
• Maintain and update records related to pre-approvals and reconciliation for insurance company audit and DHA inspection
• Expertise in empanelment and negotiation.
• The inclusion of new services and its price lists to be added in the existing agreed tariff of Networks/Insurance companies.
• Create a detailed summary report of filled claims each month and keep track of the payments
• Oversee and review processed claims with denial reasons and discrepancies, to minimize revenue loss and maximize reimbursement
• Well-versed with DHA protocols and E- claims DHPO portal.
• Comply with the DHA and all legal requirements regarding coding procedures and practices
• Conduct insurance audits and coding reviews to ensure all documentation, and codes are accurate and precise on a daily basis
• Correspond with all insurance companies about their queries and clarifications.
• Manage good relations with major insurance companies and Brokers.
• Provide administrative support and Training to the Customer service team, Doctors, accounts, and management about insurance circulars
• Coordinate and network between patients, physicians, and insurance companies.
• Work towards Increasing the number of insurance patients footfall in clinic and insurance revenue generations.
• Design and implement a protocol for insurance practices in the clinic
• Ensure KPIs for the insurance companies are up to date and are met in general
• Be up to date about UAE Medical coding rules and regulations.

Job Type: Full-time Application Question(s):

• Can you start immediately?
• How many years of UAE experience do you have?
• How many years of submission and re-submission experience do you have?