RCM Coordinator (Emirati National)

Pre-Authorization Approval Processing and Turnaround • Facilitate securing service approvals from patients’ insurance companies • Ensure approvals meet the agreed turnaround time (outpatient within 24 hours; inpatient within 24–48 hours) • Send all approval requests on the same day • Escalate cases that exceed the agreed turnaround time to the Pre-Authorization Supervisor Communication and Documentation • Review and release all approvals (e-mail or RHES) to the respective clinic • Prepare cost estimates for insurance and cash patients Tracking and Data Management • Maintain an up-to-date Approval Request Tracker and save it in the shared folder • Maintain an updated Insurance Master, share it with internal stakeholders, and save it in the shared folder. Training and Stakeholder Support • Assist the Pre-Authorization Team Lead in delivering training on insurance policies and procedures to internal stakeholders (patient administration, nurses, doctors) • Support providing updates on insurance policies and procedures (via email or in-person sessions) to internal stakeholders. Escalation and Issue Reporting • Report issues or discrepancies to the Pre-Authorization Team Lead (for example, insurance policy clarifications or information technology infrastructure concerns) Coordination and Work Practices • Complete assigned tasks in coordination with the supervisor or manager • Demonstrate flexibility to work in shifts and during public holidays Claims Operations Claim Submission and Billing Operations • Responsible for claim submission for all facilities (Dubai Hills, Jumeirah, and Marina) or as assigned to the employee. • Lead electronic billing and assign tasks to dispatch staff • Prepare and generate Extensible Markup Language files and troubleshoot in the electronic claim system • Ensure timely, high-quality dispatch of physical and electronic invoices to accelerate payments and reduce rejections • Coordinate with insurance companies on electronic billing and submission matters Coding and Tariff Integrity • Identify discrepancies in Current Procedural Terminology, Healthcare Common Procedure Coding System, and tariffs; escalate to the Revenue Cycle Management Assistant Manager – Claims Operations. Review, Screening, and Issue Resolution • Conduct daily screening and review of insurance claim forms and related documents for completeness • Review claims flagged with issues by the claims team and escalate to the concerned team (for example, the Prior Authorization team). Reporting and Monitoring • Prepare weekly under-dispatch reports for outpatient and pharmacy • Monitor and audit the claim-submission vendor and escalate performance issues to the Revenue Cycle Management Assistant Manager – Claims Operations. Cross-Functional Coordination • Coordinate with laboratory, pharmacy, front office, and hospital branches to ensure smooth workflow. Training and Development • Train and onboard new claims staff for outpatient submission Payer Relations Payer Network Management & Coordination • Support the execution of payer onboarding and credentialing processes, ensuring compliance with payer requirements and regulatory standards. • Maintain and update the hospital’s insurance network matrix and payer participation status. • Coordinate internal documentation required for network agreements, renewals, and re-credential

Pre-Authorization: Facilitate securing service approvals from patients’ insurance companies; Ensure approvals meet the agreed turnaround time (outpatient within 24 hours; inpatient within 24–48 hours); Send all approval requests on the same day; Escalate cases that exceed the agreed turnaround time to the Pre-Authorization Supervisor. Communication and Documentation: Review and release all approvals (e-mail or RHES) to the respective clinic; Prepare cost estimates for insurance and cash patients. Tracking and Data Management: Maintain an up-to-date Approval Request Tracker and save it in the shared folder; Maintain an updated Insurance Master, share it with internal stakeholders, and save it in the shared folder. Training and Stakeholder Support: Assist the Pre-Authorization Team Lead in delivering training on insurance policies and procedures to internal stakeholders (patient administration, nurses, doctors); Support providing updates on insurance policies and procedures (via email or in-person sessions) to internal stakeholders. Escalation and Issue Reporting: Report issues or discrepancies to the Pre-Authorization Team Lead (for example, insurance policy clarifications or information technology infrastructure concerns). Coordination and Work Practices: Complete assigned tasks in coordination with the supervisor or manager; Demonstrate flexibility to work in shifts and during public holidays. Claims Operations: Lead claim submission for all facilities; Lead electronic billing and assign tasks to dispatch staff; Prepare and generate XML files and troubleshoot in the electronic claim system; Ensure timely, high-quality dispatch of physical and electronic invoices to accelerate payments and reduce rejections; Coordinate with insurance companies on electronic billing and submission matters. Coding and Tariff Integrity: Identify discrepancies in CPT, HCPCS, and tariffs; escalate to the Revenue Cycle Management Assistant Manager – Claims Operations. Review, Screening, and Issue Resolution: Conduct daily screening and review of insurance claim forms and related documents for completeness; Review claims flagged with issues by the claims team and escalate to the concerned team. Reporting and Monitoring: Prepare weekly under-dispatch reports for outpatient and pharmacy; Monitor and audit the claim-submission vendor and escalate performance issues to the Revenue Cycle Management Assistant Manager – Claims Operations. Cross-Functional Coordination: Coordinate with laboratory, pharmacy, front office, and hospital branches to ensure smooth workflow. Training and Development: Train and onboard new claims staff for outpatient submission. Payer Relations: Payer Network Management & Coordination: Support the execution of payer onboarding and credentialing processes, ensuring compliance with payer requirements and regulatory standards; Maintain and update the hospital’s insurance network matrix and payer participation status; Coordinate internal documentation required for network agreements, renewals, and re-credentialing.