✨ AI Summary
Al Futtaim Health is seeking a Resubmission & Reconciliation Officer in Dubai, UAE. This full-time position requires managing the resubmission and reconciliation of insurance claims, ensuring compliance with regulations, and analyzing denial root causes to prevent reoccurrence. The role involves close collaboration with physicians, billing teams, and other stakeholders to enhance the claims process and mitigate financial risks. Key responsibilities include updating the insurance manager on claim issues, ensuring timely resubmissions with proper justification, and maintaining accurate monthly data.
The ideal candidate will have a Bachelor of Commerce degree, with a preference for an MBA/PG Diploma in Business Management (Finance). A minimum of 3+ years of experience in a similar role is required, along with a strong medical background, negotiation skills, and excellent presentation and analytical abilities. Certified professional coding and medical/paramedical certificates are also mandatory.
To update Insurance manager about unusual denial / issues from Insurance Companies for further discussion and resolution.Ensure timely resubmissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.Internal Follow up for raised QMS to concerned branchCommunicating with the payers for any clarification regarding the rejected claims at 1st resubmission and 2nd resubmission-reconciliation stage.Interacting with the physicians for the clinical justification o
Requirements
Required skills to be successful:
Job-Specific Skills:
Behavioural Competencies:
Excellent presentation and analytical skills
Good decision-making skills
Strong operational thinking skills
Strong dedication skills
Ability to work under pressure to achieve target
What qualifies you for the role:
Minimum Qualifications and Knowledge:
Minimum Experience:
Description
To update Insurance manager about unusual denial / issues from Insurance Companies for further discussion and resolution.Ensure timely resubmissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.Internal Follow up for raised QMS to concerned branchCommunicating with the payers for any clarification regarding the rejected claims at 1st resubmission and 2nd resubmission-reconciliation stage.Interacting with the physicians for the clinical justification on the rejected claimsEnsure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.Working closely with Insurance Approvals and Claims Submission Team to minimize the claims denialsMaking sure that claim resubmissions are dealt with according to Insurance industry and DHA regulations.Comply with re-submission KPI’s (Key Performance Indicator) , maintain a record of resubmission KPIs as and when required.Analyze the root cause for the denial by the various payers and collect timely feedback from other team members, create a special rules in the system to prevent the reoccurrence of those denialsEducate billing/Approval team to enhance the process flow.Ensures that targets are met with in turnaround time and while maintain quality and productivity.Coordinate with CDI team to educate the physicians, and other paramedical team to ensure proper claims documentations.Maintain accurate monthly data of claims resubmissions /reconciliations of each insurance companyMaintain a detailed statement of insurance denials segregated to technical denials and medical denials to facilitate the proper denial management plan and required training and documentation enhancementHighlight payment discrepancies by various payers to LM knowledge.Coordination with other business stakeholders to improve overall resubmission /recon process efficiency.Analysis of financial data related to revenue cycle, to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risk/s.