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