Duties and Responsibilities:

• To obtain for inpatient and outpatient cases for all insurance patients.
• Responsible for Participation in interdepartmental teams to identify operational requirement, problem solve and develop process for care contracts.
• Responsible for daily following of approvals of the companies’ patients.
• Responsible for Fulfilling all medical reports for out-patients & in-patients if needed
• Responsible for Following the utilization and services requested for co. patients and discussing with all attending doctors
• Responsible for getting approvals for medically justified and covered investigations as per policy and special approval such as C.T & physiotherapy for prior approval and evaluating the cases that doesn’t need approval
• Responsible for Insuring timely response to inquiries concerning authorization issues
• Responsible for Preparing monthly companies reconciliation
• Responsible for supervising the performance of the outpatient department with company patients.
• Responsible for Representing the NEOM Hospital in external and internal business that assigned to him / her to be done within the scope of the department and NEOM Hospital policies.
• Calculate and issue invoices for cash patients and discharge the patients.
• Check the approval for company / insurance patients.
• Calculate and issue invoices for services not covered by the respective company / insurance.
• Prepare company / insurance invoices.
• Prepare the daily Discharge Summary Reports.
• Prepare the daily and monthly statement of all external doctors.
• Prepare estimation of patient invoices for insurance with maximum limit and cash patient.
• Prepare the daily Discharge Summary Reports.
• Apply PKD if any, Apply Room Difference if any.
• Apply itemized services if any.
• Identifying the provided services either (included / excluded) from PKGs.
• Allocating provided services accordingly, Applying the discounts accordingly, save the performed actions, Invoice generation.
• Provide patient with admission & discharge policy, time of admission and room selection
• Verify patients’ identification and financial benefit to determine admission eligibility
• Greet the patient, enter the demographic information, insurance information and obtain the signature on the legal consent & forms
• Prepare admission file with all necessary hospital paper like, consent and policies before the scheduled appointments
• Maintaining the log note for VIP suites reservation request
• Follow up with patients who are willing to postpone their admission and inform them to reschedule the admission date
• 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.

OTHER SKILLS AND ABILITIES :

• Able to recognize and accept ownership and propose solutions.
• Tackles problems in professional manner and develops measures to prevent problems
• Excellent Communication Skills
• Must be able to clearly communicate with health plans, physicians and vendors.
• Must be detailed oriented.

JOB REQUIREMENTS / QUALIFICATIONS :

Education:

Bachelor Degree in Business Management or related field

Experience:

0 – 2 years’ experience in related field or insurance companies

Language:

Fluent in Arabic & English Required Licenses: N/A