JOB DESCRIPTION
Responsible of securing 80% of clinic revenue as its covered under insurance. Managing claiming and billing process internally and externally with excellence. Performs audits on insurance claims to ensure full governance and compliance on the claiming and billing process and raise internal physicians awareness on CCHI and Insurance provider policy including diagnosis and provisions of care using his/her medical expertise. Acts as an ultimate owner of Nahdi Care clinic claiming and billing SPOC with stakeholders and ensures full claiming accuracy by reducing rejection rate to less than 5%. Analyzes and Reporting data to top management and proactively lead decisions that avoid rejection rate to avoid any negative implications of clinic reputation within insurance providers and financial impact of clinic profitability.
Accountabilities
Ensure delivering 80% of clinic profit with excellence
Design and implement Best In Class Claiming and Billing processes
Comply with NCC<CCHI,CBAHI requirements and regulations
Lead processes governance and performs audits
Analyze claiming data and report to top management to identify issues and gaps
Raise internal physicians and insurance officers awareness on claiming process, diagnosis and provisions of care
Reduce claims rejection to less than 5%
Manage guests and insurance companies complaints professionally and ensure one time resolutions
Collaborate with IT and Finance to ensure systematic handling of claiming and billing with minimal human touch to reduce errors
Continuously improve claiming and billing process
Builds collaborative relations ships and networks with different external stakeholders
Minimize any potential impact on Nahdi Care clinic reputation or profit
Masters negotiation with insurance companies in case of claims rejections before reconciliations.
Employee duties are not limited only to the above-mentioned Accountabilities; he/she may perform other duties as assigned.
Work Environment
Indoors : 100%
Outdoors : 0%
Working Days : 6 Working Days
Days off : 1 Day Off
Working Hours : 8 net working hours according to shift schedule approved by head of department.
Job Requirement
Education
Bachelor’s degree in medicine or in pharmacology
Experience
7+ years in Medical Insurance provider or medical insurance department within health care sector (hospital or medium sized clinic)
Computer Skills
Advanced level of Excel, Moderate in Ms. Office.
Languages
English and Arabic (fluent spoken and written)
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