Submission Officer (Corniche Hospital)
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Key skills for this role
About the Role
SEHA is seeking a Submission Officer to manage healthcare insurance claims and billing processes at Corniche Hospital. The role involves validating claims, resolving rejections, and ensuring compliance.
Key Skills for This Role
Responsibilities
- Monitor compliance to insurance company's terms and conditions
- Ensure compliance by the facility pricing structure and the rules for different patient categories
- Assist in collecting and processing claims
- Validate the claimed outpatient services (Laboratory, Radiology and Pharmaceuticals)
- Check the claim invoices (inpatient and outpatient)
- Generate and regenerate the missed and incorrect invoices
- Process each claim in the system
- Attend and answer financial matters to patient and specialty clinics inquiries
- Prepare statement of accounts
- Follow up the claims submission to the insurance company
- Ensure that all insurance documents have been properly filled and claiming related amount
- Resubmit the rejected claims with a wrong reason or without reason and unpaid claims
Requirements
- Bachelor's Degree or Diploma in any related field (medical/health science)
- AAPC or AHIMA Certification
- 2 4 years of relevant progressive experience in a similar role
- Experience in a large healthcare facility (desired)
Full Job Posting
Job Description
- The Submission Officer is responsible for managing and monitoring healthcare insurance claims and billing processes to ensure compliance with insurance policies, contractual agreements, and facility pricing guidelines.
- The position involves validating and processing inpatient and outpatient claims, resolving rejected or unpaid claims, preparing financial documentation and statements, and ensuring accurate insurance related records.
- This Officer also provides financial support to patients and clinics, addresses inquiries, identifies and resolves billing issues, and contributes to process improvement initiatives while collaborating with internal teams to enhance operational efficiency and compliance.
Responsibilities
- Monitoring compliance to insurance company's terms and conditions
- Ensuring compliance by the facility pricing structure and the rules for the different patient categories (including self payer) with implementation
- Assisting in collecting and processing claims
- Validating the claimed outpatient services (Laboratory, Radiology and Pharmaceuticals)
- Checking the claim invoices (inpatient and outpatient)
- Generating and regenerate the missed and incorrect invoices
- Processing each claim in the system
- Attending answering about financial matters, to patient and Specialty clinics inquiries
- Preparing statement of accounts
- Following –up the claims submission to the insurance company
- Ensuring that all insurance documents been properly filled and claiming related amount
- Resubmitting the rejected claims with a wrong reason or without reason and unpaid claims
Qualifications
- Qualification: Bachelor's Degree or Diploma in any related field (medical/health science)
- Special Certificate: AAPC or AHIMA Certification
- Required: 2 4 years of relevant progressive experience in a similar role
- Desired: Experience in a large healthcare facility
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