Job Description

CATEGORY

Non Faculty Vacancies

COLLEGE

Departments

DEPARTMENT

University Dental Hospital Sharjah

JOB PURPOSE

To liaison between the Center of Excellence for Dental Medicine (CEDM ) and insurance companies by handling insurance inquiries, resolving issues, fulfilling requests, and maintaining the insurance database. The role ensures accurate dental coverage details, checks pre-approvals, is responsible for claims processing via provider/payer software, and ensures compliance with the policies and guidelines of regulatory bodies such as MOHAP and EHS.

MAIN ACCOUNTABILITIES & EXPECTATIONS

1. Review and understand all relevant UOS policies and procedures in order to be able to carry out daily work tasks as accurately and efficiently.
2. Verify patient eligibility for dental treatment by checking insurance policies and coverage details using payer portals and systems.
3. Obtain necessary pre-authorizations or approvals from insurance providers for specific treatments or procedures, ensuring compliance with insurance requirements.
4. Accurately update and maintain patient insurance information in the related system, ensuring data integrity and completeness.
5. Inform patients about their insurance coverage, potential out-of-pocket expenses, and payment options.
6. Review and confirm assessments for prescribed dental treatments, ensuring alignment with insurance coverage and coding guidelines.
7. Accurately code dental procedures and diagnoses using CDT codes for claims submission.
8. Prepare, submit, and track electronic and paper insurance claims to various patients within specified timelines.
9. Manage direct billing processes, ensuring accurate and timely submission of claims to insurance companies.
10. Monitor the status of submitted claims, following up with insurance companies to resolve any issues or delays.
11. Respond to inquiries from patients regarding submitted claims, providing necessary documentation or clarifications.
12. Process reimbursement requests from patients when insurance does not cover the treatment costs, adhering to established procedures and policies.
13. Communicate with dentists and clinical staff regarding insurance coverage, pre-authorization requirements, and excluded treatment codes.
14. Notify and inform clinicians about any rejected or denied treatment codes, providing reasons and alternative solutions.
15. Collaborate with the Finance Department to reconcile claim payments and resolve billing discrepancies.
16. Provide claims processing and approval status updates to Patient Relations Officers/Receptionists.
17. Prepare patient treatment claim summaries for practicing doctors as needed, and prepare and submit accurate and timely claims submission reports to patients.
18. Ensure adherence to the policies and guidelines of regulatory bodies such as MOHAP and EHS.
19. Stay updated on changes in insurance regulations, policies, and coding guidelines.
20. Participate in audits or reviews of claims processing activities to ensure accuracy and compliance.
21. Maintain organized records of all claims, correspondence, and related documentation, ensuring compliance with record-keeping requirements.
22. Generates weekly reports on claims processing metrics for review by the line manager. As well as identify and report any discrepancies or potential issues in the claims process.
23. Complete any other job-related

REQUIRED SKILLS

Excellent oral and written communication skills and the ability to prepare professional documents, in both Arabic and English.

Excellent working knowledge of personal computer applications with an emphasis on MS Office applications such as Excel, Word, and Teams.

Knowledge of Dental Terminologies, Treatment Plans, and CDT codes.

Knowledge of healthcare billing and coding, and insurance processing.

DESIRABLE REQUIREMENTS

Minimum of bachelor's degree in Healthcare Administration, Dental Surgery, or Business Administration with a focus on Healthcare Management or a healthcare-related discipline.

A certification in insurance or claims-related courses (such as Health Insurance Claims Management or Medical Insurance Operations) is required.

2-4 years of UAE experience in a similar role, preferably in healthcare institutions.

Priority is to UAE Nationals.

JOB LOCATION

University of Sharjah (Main)

JOB CRITERIA

GENDER

, Male, Female,

QUALIFICATIONS

Bachelor's degree/higher diploma

RELEVANT EXPERIENCE

2

LIVING IN UAE

Open for all

NATIONALITY

, All,