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Approval Physician

Company
Internal
LOCATION
Internal
JOB Type
Full-time
Requisition ID
2400003Q

Duties and Responsibilities:

  • Researches and analyzes denial data and coordinate denial recovery responsibilities.
  • Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials
  • Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.
  • Uses reports that categorize denials to assign tasks or personally work to overturn denials Identifies and pursues opportunities for improvements in denial performance
  • Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts
  • Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks Performs inpatient, ambulatory surgery, emergency room, outpatient and evaluation/management coding audits on the team members work
  • Responsible for providing billing compliance education to all physicians and advanced practice practitioners within the division
  • Provide feedback of audit findings to physicians and conduct post-audit training sessions as audit results Supervising and processing the In-Patient approvals
  • Ensuring that the correct current procedural terminology, or CPT, and international classification of disease, or ICD-9, codes are used
  • Demonstrates compassionate communication skills while providing support and care to the patients as “the patient is the center of our care”.

    Other Job Functions:


  • Perform all duties and tasks in line with the Person Centered Care values.
  • Adherence to all policies, plans and programs within the Fakeeh Care.
  • Perform duties as per the code of conduct requirement and ethical standards as outlined in the HCM policies and guidelines.
  • Complete mandatory education as per the requirement at least one month prior to expiration.
  • Maintain up to date knowledge on information relating to quality and safety, accreditation, policy management and document management systems.

JOB REQUIREMENTS / QUALIFICATIONS :

    Education:

    Bachelor degree in Surgery and Medicine

    Experience:

    Healthcare industry experience is preferred, relevant experience in insurance role is preferred

    Language:

    Arabic & English

    Required Licenses:

    N/A
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