Medical Insurance Claiming & Billing Manager (190610)

Responsible of securing ‎80% of clinic revenue as its covered under insurance.
Managing claiming and billing process internally and externally with
excellence. Performs audits on insurance claims to ensure full governance and
compliance on the claiming and billing process and raise internal physicians
awareness on CCHI and Insurance provider policy including diagnosis and
provisions of care using his/her medical expertise. Acts as an ultimate owner
of Nahdi Care clinic claiming and billing SPOC with stakeholders and ensures
full claiming accuracy by reducing rejection rate to less than ‎5%. Analyzes
and Reporting data to top management and proactively lead decisions that avoid
rejection rate to avoid any negative implications of clinic reputation within
insurance providers and financial impact of clinic profitability.
Accountabilities
* Ensure delivering ‎80% of clinic profit with excellence
* Design and implement Best In Class Claiming and Billing processes
* Comply with NCC<CCHI,CBAHI requirements and regulations
* Lead processes governance and performs audits
* Analyze claiming data and report to top management to identify issues and gaps
* Raise internal physicians and insurance officers awareness on claiming process, diagnosis and provisions of care
* Reduce claims rejection to less than ‎5%
* Manage guests and insurance companies complaints professionally and ensure one time resolutions
* Collaborate with IT and Finance to ensure systematic handling of claiming and billing with minimal human touch to reduce errors
* Continuously improve claiming and billing process
* Builds collaborative relations ships and networks with different external stakeholders
* Minimize any potential impact on Nahdi Care clinic reputation or profit
* Masters negotiation with insurance companies in case of claims rejections before reconciliations.
Employee duties are not limited only to the above-mentioned Accountabilities;
he/she may perform other duties as assigned.
Work Environment
* Indoors : ‎100%
* Outdoors : ‎0%
* Working Days : ‎6 Working Days
* Days off : ‎1 Day Off
* Working Hours : ‎8 net working hours according to shift schedule approved by head of department.
Job Requirement
Education
* Bachelor 's degree in medicine or in pharmacology

Experience
* ‎7+ years in Medical Insurance provider or medical insurance department within health care sector (hospital or medium sized clinic)

Computer Skills
* Advanced level of Excel, Moderate in Ms. Office.

Languages
* English and Arabic (fluent spoken and written)