Resubmission & Reconciliation Officer

Job description / Role

Established in the 1930s as a trading business, Al-Futtaim Group today is one of the most diversified and progressive, privately held regional businesses headquartered in Dubai, United Arab Emirates. Structured into five operating divisions; automotive, financial services, real estate, retail and healthcare; employing more than 35,000 employees across more than 20 countries in the Middle East, Asia and Africa, Al-Futtaim Group partners with over 200 of the world's most admired and innovative brands. Al-Futtaim Group's entrepreneurship and relentless customer focus enables the organization to continue to grow and expand; responding to the changing needs of our customers within the societies in which we operate.

By upholding our values of respect, excellence, collaboration and integrity; Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day

About the role:
- To update Insurance manager about unusual denial / issues from Insurance Companies for further discussion and resolution.
- Ensure timely resubmissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.
- Internal Follow up for raised QMS to concerned branch
- Communicating with the payers for any clarification regarding the rejected claims at 1st resubmission and 2nd resubmission-reconciliation stage.
- Interacting with the physicians for the clinical justification on the rejected claims
- Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.
- Working closely with Insurance Approvals and Claims Submission Team to minimize the claims denials
- Making sure that claim resubmissions are dealt with according to Insurance industry and DHA regulations.
- Comply with re-submission KPI's (Key Performance Indicator) , maintain a record of resubmission KPIs as and when required.
- Analyze the root cause for the denial by the various payers and collect timely feedback from other team members, create a special rules in the system to prevent the reoccurrence of those denials
- Educate billing/Approval team to enhance the process flow.
- Ensures that targets are met with in turnaround time and while maintain quality and productivity.
- Coordinate with CDI team to educate the physicians, and other paramedical team to ensure proper claims documentations.
- Maintain accurate monthly data of claims resubmissions /reconciliations of each insurance company
- Maintain a detailed statement of insurance denials segregated to technical denials and medical denials to facilitate the proper denial management plan and required training and documentation enhancement
- Highlight payment discrepancies by various payers to LM knowledge.
- Coordination with other business stakeholders to improve overall resubmission /recon process efficiency.
- Analysis of financial data related to revenue cycle, to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risks.

Requirements

Required skills to be successful:

Job-Specific Skills:
- Strong medical background to handle reconciliation efficiently.
- Strong Negotiation skills
- Strong soft skills

Behavioural Competencies:
- Excellent presentation and analytical skills
- Good decision-making skills
- Strong operational thinking skills
- Strong dedication skills
- Ability to work under pressure to achieve target

What qualifies you for the role:

Minimum Qualifications and Knowledge:
- Certified professional coding certificate from reputed institution
- Certified medical /paramedical certificate

Minimum Experience:
- Minimum 3+ years' experience in a similar role.

About Al-Futtaim Healthcare

We Hear Your Ambition.
For over 90 years, the Al-Futtaim Group has been bringing the world's leading brands of lifestyle watches, cars, home furnishings and fashion to the UAE. The Group has now introduced a whole new way of holistic healthcare through HealthHub Clinics by Al-Futtaim, its multi-speciality chain of more than 20 clinics in Dubai with over 25 specialties offering the right combination of advanced diagnostics, proven medical expertise and specialised services .
What gives our clinics an edge is that as a part of the Al-Futtaim Group, you can expect world-class quality standards, with access to the best medical services and facilities within a healing environment. It's a new way of healthcare that's designed to meet a patient's needs with a complete range of smart healthcare solutions. As testimony to this, only recently, we've earned a rare milestone of being the only primary healthcare network in the UAE to receive the Gold Seal by a reputed international body: Accreditation Canada.
As trusted partners to health, we at HealthHub Clinics adopt evidence-based learning that enables us to listen to our patients more carefully. It helps us in treating the cause and not just the symptoms, while applying global best practices to ensure quality of care for every family member. Most of all, we adopt a patient-centric approach to healthcare that is reflected in the promise of our core belief: " We Hear You. "

About the Company

Established in the 1930's, the Al-Futtaim Group initially operated as a trading enterprise. Rapid development throughout the 1940's and 50's saw it establish itself regionally as an integrated commercial, industrial and services organisation, positioning itself one of the leading business houses in the lower Gulf region. Today, it operates collectively over 40 companies bearing the Al-Futtaim name, dominates many market segments in the UAE, and has expanded its sphere of operation to include Bahrain, Kuwait, Qatar, Oman and Egypt.

The Group comprises a diverse range of strategically positioned operating subsidiaries and associate companies, structured to give the Al-Futtaim Group the flexibility and versatility to keep ahead of local competition while keeping pace with the ever-evolving global business scenario. The Groups continued investment in world-class systems technology is clear evidence of its commitment to maintain leading edge performance and service delivery.

The success of the Al-Futtaim Group can be attributed to a business approach that combines the ability to change with the traditional values of integrity, service and social responsibility that define its core business philosophy. This, linked with the Groups belief in decentralisation, gives the heads of the operating companies a high degree of functional autonomy and authority, providing the Group with essential flexibility, and individual employees a clearly defined work culture and sense of responsibility.