Officer, Insurance Services

Overview

The Officer, Insurance Services is accountable for providing vital support to the finance and insurance teams in their daily insurance activities. This multifaceted role involves various responsibilities, including but not limited to handling authorizations, submissions, resubmissions, and processing medical claims. The Officer ensures that all insurance-related tasks are carried out in strict accordance with MH's relevant insurance procedures and guidelines. Their dedication and attention to detail contribute significantly to the smooth functioning of insurance operations, ultimately facilitating efficient patient care.

Responsibilities

• Ensure high accuracy in claims processes for insurance and corporate review, adhering to contractual agreements for efficient reimbursement.
• Provide customer service support for insurance verification, eligibility, and preauthorization.
• Accurately liaise with staff to ensure timely entry of insurance information and benefits.
• Verify claims compliance with billing guidelines.
• Communicate insurance guidelines and procedures to front-line staff.
• Support other departments and payers in tracking payments.
• Maintain proper records and files for claims correspondence with insurance and private or corporate businesses.
• Contribute to developing insurance guidelines, frameworks, and processes within M42.
• Analyze claim adjustments, bad debt provisions, and contractual allowances.
• Perform accuracy checks for all claim submissions and resubmissions as per agreed contracts.
• Coordinate discussions between billing clerks and utilization nurses for insurance claims process.
• Manage a collection desk for outstanding balances in the revenue cycle process.
• Develop claim reports for analysis and performance measurement.
• Develops and maintains relationships with insurance carriers to stay up to date with all billing and processing requirements.
• Responds to insurance related queries/complaints from both internal and external customers.
• Pro-actively participates in collaboration with the Line Manager to meet the division's strategic and operational goals.
• Adheres to the division's policies, procedures and standards while ensuring compliance with applicable regulatory bodies.
• Provides recommendations towards improving the division's policies and procedures wherever applicable.
• Contributes towards an innovative culture of continuous improvement for enhancing operational efficiency and effectiveness.
• Participates in meetings and maintain professionalism and confidentiality as per the organization's standard code of conduct.
• Maintains patient privacy, confidentiality, security and standards of ethics in all phases of release of the patient’s medical information.
• Timely completion of personal performance evaluation cycle
  
  

Qualifications

Required:

• Bachelor’s Degree in Finance, Accounting,Business Administration or related fields.
• 0-2 years of progressive career experience in Finance/Accounting/Insurance environment in a healthcare facility.
• Strong analytical and problem-solving skills.
• Knowledge of revenue cycle management within the healthcare environment.
• Knowledge of basic medical coding and third-party operating procedures and practices.
• Knowledge of medical billing/collection practices.
• Proficiency with Microsoft Office suite.
• Fluency in written and spoken English.
  
  

Desired:

• Certification in Coding.
• Experience in insurance practices in the UAE.
• Fluency in written and spoken Arabic.