Claims Officer – Approvals

Job Description

Basic Purpose of the role

The Claims Officer is responsible for overseeing the hospital claims process and related issues. The Claims Officer shall ensure that the financial activities for patients shall run efficiently and effectively according to best international standards by following the facility’s approved policies and procedures. 

Key responsibilities of the role

• Assists in formulating and ensuring delivery of the Hospital corporate strategies and strategic plans.
• Acting as a role model, they will deliver high operational performance standards by developing and supporting the Finance team.
• Collaborates with all levels of interdisciplinary teams, executive officers and other stakeholders in the development, implementation, and evaluation of programs and services.
• Coordinating and participating in reviewing the Claims Policy and Procedures on a regular basis and providing relevant inputs to the Senior Claims Officer
• Monitoring and evaluating the efficiency and effectiveness of the service delivery process and identifies opportunities for improvement.
  Complying by the  rules and the contractual terms and agreement with the insurance companies
• Complying by the facility pricing structure and the rules for the different patient categories (including self-payer) with implementation 
• Checking and reviewing the approved procedures codes (for inpatient) from the Insurance Company, with the facility coders and the service points
• Collecting and receiving the outpatient and inpatient claims from the service points and admission office
• Checking the claim invoices (inpatient and outpatient) 
• Generating and regenerating the missed and incorrect invoices
• Processing each claim in the system
• Assisting the Senior Claims Officer  in preparing a statement of accounts
• Following-up the claims submitted to the Insurance Company
• Conducting follow-up on claims unpaid, partially paid or denied, including appeals and resubmission to the insurance company
• Maintaining claims documentation
• Maintaining and reporting claims processed data
   

Other responsibilities

• Evaluates factors related to safety, outcomes, effectiveness, cost and social impact when developing and implementing practice innovations.
• Participates in projects, equipment, staff and policy decisions that affect staff care.
• Manages the performance of self and others within the facility by setting developmental action plans/goals.
• Continues personal professional development through training and continuing education.
   

Compliance guidelines

• 
  Responsible for operational implementation and for ensuring that practice is contemporary and meets international and UAE national guidelines.
• The ability to demonstrate good interpersonal relationships, and the application of sound administrative principles.
• Completes and maintains all regulatory requirements including: licensure and certification and other mandatory training within established time frames.
  Demonstrate a high standard of active listening skills as well as other verbal and written communication skills.
• Ensures all staff maintains confidentiality regarding staff/patient information.
  Maintaining collaborative and effective relationships with other key management personnel and keeps abreast of significant economic, social and technical trends and regulatory guidelines, which may influence assigned functions/services and/or the facility.
• Functions as a resource to all Staff and acts as liaison with other disciplines and departments.
• Responding to verbal and written inquiries in a timely manner
• Delivering solutions to simpler issues facing the employees and presenting complex issues to the Officer/Senior Officer 
• Corresponding with different vendors for the purpose of account verification and details of payment
• Maintain a positive work environment for staff and promote team efforts, promote and maintain effective working relationships with all levels of staff.
• Adheres to the policies of Occupational Health and Safety and Infection Control Guidelines in all work practices.
  Establish and maintain professional interpersonal relationships – Developing constructive and cooperative working relationships with others and maintaining them over time.
• Emotionally self-aware, practice self-control, able to empathetically interact and understand the team and their needs and demonstrates effective management of relations to ensure team success and better patient care outcomes.
• Acts as a professional role model and resource person.

Qualifications, Certifications and Experience

• Bachelor’s degree or Masters equivalent in Business Administration/Accounting/Finance/Commerce or relevant field 
• Competent computer skills.
• Recognised accountancy qualification such as CMA,CPA,ACCA,ACA,CA,CFA or equivalent
• Knowledge of of CPT, HCPCS and revenue coding etc.
• 2 years of relevant progressive experience in a similar role   within  a major healthcare company or division of a large healthcare corporation.
• International accreditation experience.
• The ability to influence and implement change.
• Excellent interpersonal and communication skills.
• Strong analytical and problem-solving skills                
• Able to work independently and collaboratively with others.
• Organized and able to work methodically.
• Excellent leadership skills.
• Able to relate to people from different cultural backgrounds.
• Fluent in both written and spoken English.
• The ability to speak Arabic is highly preferred.

Physical requirements

Typical physical demands include: a high degree of manual dexterity to sufficiently perform computer functions on a keyboard, produce materials on a PC and operate basic office equipment, normal or corrected vision and hearing, extensive sitting and walking, mobility sufficient to visit with departments or employees throughout the facility and lift up to 13 kgs.