Senior Insurance officer, Revenue Cycle Management
Nation Hospital
Total years of experience :15 years, 3 Months
• Create schedule of benefits template in the system and maintain updated data of existing plans.
• Ensure active standard provider contracts (SPCs) with insurance companies and maintain renewal terms and conditions.
• Preparing documents and Empaneling with insurance companies.
• Updating the price factor in the system and monitoring the price applied properly.
• Handles patient’s complaints concerning insurance coverage.
• Maintaining documents for the renewal process.
• Communicate with Insurance companies related to the coverage and networks.
• Reflect agreed prices, specific conditions of approvals, policies exclusions in the system.
• Educates other patient access staff on health insurance regulations, updates and changes.
• Review of agreements, renewal of contracts, negotiations, network selection
• Will have to possess and maintain an insurance assistance options such as special approvals and GOPs in liaison with the prior authorization team.
• Rounds in the hospital emergency department to ensure patient payment liability is resolved post patient stabilization.
• Handles all complex insurance (coverage) discussions with patients and families for cases not covered by insurance and performs scheduling functions for self - pay patients.
• Resolves work queues for insurance claims clearance within slAs to ensure scheduling for patient’s appointment is not delayed.
• Proactively liaise with finance team to discuss patient’s financial issues and works with patients and families towards finding the most appropriate solution.
• Performs financial analyses and reporting as required by director and monitors performance dashboards that reflect access to patient care, patient flow and patient cost -share collection.
• Liaise with finance to obtain and collect necessary financial data to help qualify patients for the best financing option.
• Handles patients’ complaints concerning insurance coverage.
• Develops forms, letters to communicate with insurers @ HAAD.
• Flexibility in handling international patients including coordination, follow -up and understanding of international health insurance business programs.
• patient registration, patient scheduling or patient billing in a supervisory or team leader capacity.
• Possess a wide knowledge of the market health insurance plans.
• Vast knowledge of medical terminology, insurance, hospital operations is required.
• Ability to demonstrate genuine concern for patients and patient satisfaction
• MAFRAQ HOSPITAL, Abu Dhabi, UAE (February 2009 -July2016 )
Assistant Claims Officer in Business office, Revenue Cycle Management:
(April 2009 - August 2012)
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 officer in preparing statement of accounts.
Following-up the claims submission to the insurance company.
Maintaining claims documentation.
Claims Officer in Business office, Revenue Cycle Management:
(October 2012-July2016)
Monitoring compliance the rules and the contractual terms and agreement with the Insurance companies.
Ensuring compliance by the facility pricing structure and the rules for the different patient categories (including self-payer) with implementation.
Validating the claimed outpatient services ( Laboratory, Radiology and Pharmaceuticals )
Checking the claim invoices (inpatient and outpatient).
Generating and regenerate the missed and incorrect invoices.
Processing each claim in the system.
Attending answering about financial matters, to patient and Specialty clinics inquiries.
Preparing statement of accounts.
Assisting the Assistant Officer Following -up the claims submission to the insurance company.
Ensuring that all insurance documents been properly filled and claiming related amount.
Comparing the cancelled receipts received from cashiers on monthly basis to ensure that there are no manipulations in canceling transaction.
Resubmitting the rejected claims with a wrong reason or without reason and unpaid claims.
Responding to verbal and written financial inquiries in a timely manner.
Providing technical expertise in identifying potential financial /Accounting issues.
Discussing with Manger/Senior/Officer if necessary, before recommending solutions after obtaining and verifying information.
Participating in cross-functional teams and committees as appropriate.
Serving as subject and enhancing team procedure manual and processes and discussed with Manger/Senior/Officer.
Developing and enhancing team procedure manual and processes and discussed with Manager/Senior Officer.
Complying with Policies, Procedures and Practices of the SEHA facilities and other regulatory requirements.
Maintaining positive and effective working relationships within the department / division and also with other departments /sections within facility.
Performing any other duties as may be assigned relevant to the basic responsibilities of the role
Effectively lead a team of 5 Inpatient Billers to bill a back log of inpatient claims for Mafraq Hospital with total revenue of $500 Million/year
Create a monthly report for the self-pay collections.
Making the statement for Self-Pay patient and check all the diagnosis add
• MAFRAQ HOSPITAL, Abu Dhabi, UAE (February 2009 -July2016)
Administration Assistance with Patient Financial Services Manager:
Schedule the calendar for meeting.
Connect with HR to any issues with the staff and follow up with them.
Prepare all the notes for SPFS meeting.
Monitored department stock inventory and coordinated with central stores as needed.
Create monthly reports for the staff productivity & attendance.
Perform all secretarial duties as required.
Make the Project for Patient Financial Services.
Medical Science College / Biology & Geology