Requirements
Requires a certified professional coding certificate and a certified medical or paramedical certificate. Minimum of 4+ years of experience in a leading resubmission role is necessary. Strong medical background, negotiation skills, analytical skills, and established relationships with insurance companies are essential.
Description
Job description / Role
Job Type
Full Time
Job Location
UAE
Nationality
Any Nationality
Salary
Not Specified
Gender
Not Specified
Arabic Fluency
Not Specified
Job Function
Accounting & Audit
Company Industry
Retail
About Al-Futtaim Group
Established in the 1930s as a trading business, Al-Futtaim Group today is one of the most diversified and progressive, privately held regional businesses headquartered in Dubai, United Arab Emirates. Structured into five operating divisions: automotive, financial services, real estate, retail, and healthcare; employing more than 35,000 employees across more than 20 countries in the Middle East, Asia, and Africa, Al-Futtaim Group partners with over 200 of the world's most admired and innovative brands.
Al-Futtaim Group’s entrepreneurship and relentless customer focus enables the organization to continue to grow and expand; responding to the changing needs of our customers within the societies in which we operate.
By upholding our values of respect, excellence, collaboration, and integrity, Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day.
Overview of the role
Manage timely resubmissions of claims denials.
Monitor behavioural payment of various payors and corporates to apply timely corrective action to mitigate the financial risk.
Improve the quality of claims resubmission to achieve minimal denials.
Work closely with other stakeholders to eliminate the technical denials and reduce the medical denial.
The role also includes stopping revenue loss through monitoring and coordination with all concerned stakeholders like submission and preauthorization team to facilitate timely closure of quarterly, semi-annual, and annual reconciliations and signoffs with insurance companies and TPAs as per regulatory terms.
What you will do
Facilitate and accelerate the early closures of QMS related to resubmission and reconciliation.
Interact with physicians for the clinical justification on the rejected claims.
Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.
Work closely with Insurance Approvals and Claims Submission Team to minimize the claims denials.
Make sure that claim resubmissions are dealt with according to insurance industry and DHA regulations.
Ensure team's compliance with re-submission KPIs (Key Performance Indicators) and maintain a record of resubmission KPIs as and when required.
Manage timely resubmissions of all eligible IP, OP, and pharmacy claims with proper medical and technical justification.
Analyse the root cause for the denial by the various payers and collect timely feedback from other team members; create special rules in the system to prevent the reoccurrence of those denials.
Educate billing and approval team to enhance the process flow.
Ensure that each member of the reconciliation team is meeting the daily resubmission target turnaround time while maintaining quality and productivity through continuous training.
Coordinate with Clinical Documentation Improvement (CDI) team to educate physicians and other paramedical staff to ensure proper claims documentation.
Maintain accurate monthly data of claims resubmissions and reconciliations of each insurance company.
Highlight payment discrepancies by various payers to the Head of Department's knowledge.
Coordinate with other business stakeholders to improve overall resubmission and reconciliation process efficiency.
Analyse financial data related to revenue cycle to identify defaulting payors and work with the concerned department on corrective strategies to mitigate the financial risk.
Maintain a detailed statement of insurance denials segregated into technical denials and medical denials to facilitate the proper denial management plan and required training and documentation enhancement.
Required skills to be successful
Minimum qualifications and knowledge
Certified professional coding certificate from a reputed institution.
Certified medical or paramedical certificate.
Minimum experience
Minimum 4+ years’ experience in a leading resubmission role.
Job-specific skills: key skills
Strong medical background to handle reconciliation negotiation efficiently.
Strong negotiation skills.
Strong soft analysis skills.
Strong relationship with insurance companies.
Behavioural competencies
Strong leadership and supervisory skills.
Conflict management skills.
Excellent presentation and analytical skills.
Good decision-making skills.
Strong operational thinking skills.
Critical thinking skills.
What qualifies you for the role
Certified professional coding certificate from a reputed institution.
Certified medical or paramedical certificate.
Minimum 4+ years of experience in a similar role.
Strong medical background to efficiently handle reconciliation.
About Al-Futtaim Healthcare
We hear your ambition.
For over 90 years, the Al-Futtaim Group has been bringing the world’s leading brands of lifestyle watches, cars, home furnishings, and fashion to the UAE. The Group has now introduced a whole new way of holistic healthcare through HealthHub Clinics by Al-Futtaim, its multi-speciality chain of more than 20 clinics in Dubai with over 25 specialties offering the right combination of advanced diagnostics, proven medical expertise, and specialised services.
What gives our clinics an edge is that as a part of the Al-Futtaim Group, you can expect world-class quality standards, with access to the best medical services and facilities within a healing environment. It’s a new way of healthcare that’s designed to meet a patient’s needs with a complete range of smart healthcare solutions. As testimony to this, only recently, we’ve earned a rare milestone of being the only primary healthcare network in the UAE to receive the Gold Seal by a reputed international body: Accreditation Canada.
As trusted partners to health, we at HealthHub Clinics adopt evidence-based learning that enables us to listen to our patients more carefully. It helps us in treating the cause and not just the symptoms, while applying global best practices to ensure quality of care for every family member. Most of all, we adopt a patient-centric approach to healthcare that is reflected in the promise of our core belief: “We Hear You.”
About the Company
Established in the 1930's, the Al-Futtaim Group initially operated as a trading enterprise. Rapid development throughout the 1940's and 50's saw it establish itself regionally as an integrated commercial, industrial and services organisation, positioning itself one of the leading business houses in the lower Gulf region. Today, it operates collectively over 40 companies bearing the Al-Futtaim name, dominates many market segments in the UAE, and has expanded its sphere of operation to include Bahrain, Kuwait, Qatar, Oman and Egypt.
The Group comprises a diverse range of strategically positioned operating subsidiaries and associate companies, structured to give the Al-Futtaim Group the flexibility and versatility to keep ahead of local competition while keeping pace with the ever-evolving global business scenario. The Groups continued investment in world-class systems technology is clear evidence of its commitment to maintain leading edge performance and service delivery.
The success of the Al-Futtaim Group can be attributed to a business approach that combines the ability to change with the traditional values of integrity, service and social responsibility that define its core business philosophy. This, linked with the Groups belief in decentralisation, gives the heads of the operating companies a high degree of functional autonomy and authority, providing the Group with essential flexibility, and individual employees a clearly defined work culture and sense of responsibility.
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