Rcm - Manager - Insurance

7 months ago


Sharjah, United Arab Emirates Rayhan Gulf Medical center Full time

RCM - Manager:
Qualification: Graduate with Medical coding certification, preferably Nursing / medical background.

Experience: 6+ years

Job Responsibilities:

- Create and maintain standard policies and protocols for the department.
- Liaise internally with the medical, operations, nursing, paramedical, and finance departments.
- Maintain business relations and client management through interaction with insurance companies and TPAs.
- periodic review of insurance contracts for compliance.
- Act as the final authority to declare the insurance eligibility of the insured patient, i.e., serve as the approving officer for the treatment of the insured patient.
- Resolve issues and obtain approval for insured patients through communication with the TPA and insurance companies when necessary.
- Submission of claims within 7 days from the end of the previous month.
- To make sure that 100% of all claims are submitted for services that the medical Centre provides to patients.
- Follow up with insurance companies or TPAs for the payments and collect money as per the payment teams listed in the contract.
- Responsible for providing required documents and information to the DHIC and TPA/insurance company audit teams.
- Timely re-submission of the rejected claims.
- Keep track of claim status—paid, unpaid, and rejected claims.
- Ensure the smooth functioning of the department as a team leader and motivate the members to perform their best.
- Provide training to doctors, front-office staff, and back-office staff.
- Update the concerned staff or department about any changes in the policy or protocol of the insurance companies or TPAs.
- Make sure that all preapproval requests are sent to insurance companies on time and do the proper follow-up to get the same.
- Liaison with insurance companies for increasing the tariff, adding new services, etc.
- Responsible to keep the insurance disallowance less than 5%.
- Provide recommendation / suggestion to management for adding new network or insurance companies.
- Responsible for collecting sticky receivable

**Salary**: Up to AED8,000.00 per month


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