Provider Engagement Officer
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Key skills for this role
About the Role
DAMANA seeks a Provider Engagement Officer in Dubai to coordinate cost-effective medical care, manage escalated cases, and maintain relationships with network doctors and hospital RCM teams.
Key Skills for This Role
Responsibilities
- Review medical records of escalated cases to ensure requested treatments are medically necessary and align with policy coverage guidelines
- Assess the case based on escalation reason and resolve by discussing with internal departments and Providers
- Identify high quality, cost effective care pathways for cost containment
- Liaise with internal teams and providers to negotiate additional discounts on high cost claims and finalize single case agreements
- Maintain active working relationships with hospital RCM staff, billing supervisors, and authorization departments
- Collaborate with doctors, hospital Case Managers, and RCM teams to facilitate timely patient discharges
- Serve as direct contact for network doctors to resolve administrative queries and clinical process bottlenecks
- Review complex or high cost patient cases and recommend appropriate doctors and facilities
- Provide support to patients with severe or complex diagnoses, ensuring seamless coordination
- Act as communication bridge between patient, treating physician, and insurance company's internal operations
Requirements
- Bachelor’s degree in Medicine or Nursing (BSN)
- 5+ years of clinical experience
- Experience in Medical Insurance field combined with insurance case management, utilization review, or hospital side RCM/billing is an added advantage
- Medical background / coding certification is a plus
Full Job Posting
Role Overview
- Provider Engagement Officer responsible for representing SAICOHEALTH as a case manager coordinating cost effective, high quality medical care.
- Manages end to end coordination of escalated cases while maintaining strong operational relationships with network doctors and hospital RCM teams.
- Serves as primary medical matchmaker for high cost, high risk cases, guiding premium members to top tier doctors and facilities.
- Accountable for remote Disease Management program including reviewing patient submitted health records, delivering health education, and driving self management.
Main Responsibilities
- Review medical records of escalated cases to ensure medical necessity and policy coverage.
- Assess case and resolve by discussing with internal departments and Providers.
- Identify high quality, cost effective care pathways for cost containment.
- Liaise with internal teams and providers to negotiate additional discounts and finalize single case agreements.
- Maintain active working relationships with hospital RCM staff, billing supervisors, and authorization departments.
- Collaborate with doctors, hospital Case Managers, and RCM teams to facilitate timely patient discharges.
- Serve as direct contact for network doctors to resolve administrative queries and clinical process bottlenecks.
- Review complex or high cost patient cases and recommend appropriate doctors and facilities.
- Provide support to patients with severe or complex diagnoses, ensuring seamless coordination.
- Act as communication bridge between patient, treating physician, and insurance company's internal operations.
Qualifications
- Bachelor’s degree in Medicine or Nursing (BSN).
Experience
- 5+ years of clinical experience.
- Experience in Medical Insurance field combined with insurance case management, utilization review, or hospital side RCM/billing is an added advantage.
- Medical background / coding certification is a plus.
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