Submission Officer

About the role:

Timely submissions of claims.

Improve the quality of claims submission to achieve minimal initial denials.

Work closely with other stakeholders to apply securitizing rules to eliminate the technical denials and reduce the medical denial.

The role also includes stopping revenue loss through monitoring and coordination with all concerned stakeholders like preauthorization and coding team to facilitate timely closure of QMS related to claims coding clarification and coding.

Monitor behavioral payment of various payers and corporates to apply timely corrective action to mitigate the financial risk in claims submission.

What you will do:

Ensure timely submissions of all eligible IP, OP and pharmacy claims with proper medical and technical justification.

Internal follow-up for raised QMS to concerned branch.

Interacting with the physicians for the clinical justification of the claims.

Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.

Work closely with insurance approvals and claims re-submission team to minimize the claims denials.

Make sure that claim submissions are dealt with according to insurance industry and DHA regulations.

Comply with submission KPIs (Key Performance Indicators), maintain a record of submission KPIs as and when required.

Educate billing and approval team to enhance the process flow.

Ensure that targets are met within turnaround time while maintaining quality and productivity.

Coordinate with CDI team to educate the physicians and other paramedical team to ensure proper claims documentation.

Maintain accurate monthly data of claims submissions of each insurance company.

Coordinate with other business stakeholders to improve overall submission process efficiency.

Analyze financial data related to revenue cycle to identify defaulting payers and work with the concerned department on corrective strategies to mitigate the financial risks.

Required skills to be successful:

Job-specific skills:

Strong medical background to handle reconciliation efficiently.

Strong negotiation skills.

Strong soft skills.

Behavioral 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 or paramedical certificate.

Minimum experience:

Minimum 3+ years’ experience in a similar role. Proven experience in design and creative content development; strong track record in translating creative ideas into visual displays.

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.”