RCM Officer

NMC Healthcare


Date: 2 weeks ago
City: Sharjah
Contract type: Full time
  • Manages insurance approvals for insured patients both Inpatient & out patient. Liaises between NMC Royal Hospital, Sharjah, and Insurance Companies.

  • Follows insurance protocols and procedures.
  • Coordinates with clinicians and/or other clinical staff for gathering information/documentation for submission.
  • Liaises with Insurance Companies/TPAs for submitting, resubmitting, and replying queries raised by Insurance Companies/TPAs efficiently.
  • knowledge in pronouncing and understanding medical terminologies.
  • Demonstrate strong attention to details and ability to multitask within the fast- paced, high-pressure work environment.
  • Manage and track approval/denials/queries and inform clinicians and patients about the requested service(s) status.
  • Prepares cost estimation accurately for approvals as per the agreed terms.
  • To maintain an active database of the instructions/communication about Insurance Companies/TPAs from RCM Office.
  • Practices professional telephone etiquette both internal and external stake holders while making claim inquires and quickly resolving any patient complaints and concerns
  • Provides aid to Front Desk Staff regarding Insurance Protocols and Coverage.
  • Knowledge and ability to adopt/utilize computer-based applications and Microsoft Office.
  • Maintains strict confidentiality related to medical records and other data.
  • Procuring, Validating, and sending all the required information and documents while requesting preapproval from insurance companies through email, fax or online portals.
  • Procuring, validating, and sending all the required info/documents while requesting pre-approval from insurance companies through email, fax, or online portals.
  • Knowledgeable about medical coding guidelines and coding techniques (ICD10CM, CPT, HCPCS).
  • Analysing the medical data and entering it in the form of precise medical codes in online portals like e-Claim/DHPO, NeXT Care, Nas, etc. and in the Hospital Management Software.
  • Coordinating with claims team for coding updates and updated guiding principles.
  • Observing the quality parameters regularly and ensuring that the quality of coding work is maintained at a higher rate.
  • Taking pre-approval for in-patient (whenever necessary) & out-patient procedures, laboratory investigations, maternity, dental and optical cases as per the Insurance
  • Companies specific coverage.
  • Collaborate with doctors and other medical practitioners within the medical team regarding medical conditions that require specific indication on every approval (Inpatient and Outpatient).
  • Meet all key performance indicators set for call/claim handling (meet call/claim production call/claim quality, system adherence and attendance, complete call log, manage call reports).
  • Reviewing patient’s medical reports, member policy and giving internal approvals wherever necessary without any delay.
  • Reviewing the patient's medical history and replying to the queries from insurance companies, whenever there is a delay from the doctor side to reply to the query
  • Communicating with the insurance companies and checking with them whenever there is discrepancy in the approved amount (when approval is not as per agreed

  • Bachelor’s degree from an accredited college / university. Coding and claims processing skills will be preferred.
  • Minimum 2 years’ experience in a similar environment and similar role.
  • Knowledge of medical coding, Medical Billing, Insurance Policies and Protocols.
    Experience in MS Office
    Able to achieve office goals by working efficiently & providing a high level of Patient Services
    Communication Skills.

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