Insurance Manager

The Insurance Manager – JHAH Account is responsible for managing and overseeing the end-to-end insurance operations for the JHAH account, ensuring timely and accurate insurance approvals, claims submission, follow-up, reconciliation, and collections. The role ensures compliance with JHAH requirements, insurance policies, contractual agreements, and applicable healthcare regulations while maximizing revenue recovery and minimizing claim denials and financial losses. Requirements: Responsibilities - Manage the end-to-end insurance revenue cycle activities for the JHAH account, from eligibility and authorization through claims submission, reconciliation, and collection. - Oversee insurance verification, eligibility checks, pre-authorizations, and approvals for inpatient, outpatient, emergency, and other healthcare services. - Ensure accurate and timely submission of medical claims in accordance with JHAH contractual requirements and agreed billing procedures. - Monitor claim status, outstanding receivables, rejected claims, and denied claims, ensuring timely resolution and follow-up. - Analyze denial trends and identify root causes, implementing corrective actions to reduce claim rejection and improve revenue recovery. - Ensure accurate coordination between Revenue Cycle Management, Medical Departments, Coding, Billing, Finance, and other relevant stakeholders. - Maintain effective communication with JHAH representatives and relevant insurance stakeholders to resolve billing, authorization, and claims-related issues. - Monitor account receivables and collection performance, providing regular reports and updates to senior management. - Ensure compliance with contractual terms, payer policies, healthcare regulations, and internal policies and procedures. - Review and monitor insurance-related KPIs, including authorization turnaround time, clean claim rate, denial rate, collection performance, and outstanding receivables. - Develop and implement process improvements to enhance insurance operations, reduce revenue leakage, and improve cash flow. - Lead, supervise, and develop the insurance team, ensuring appropriate workload distribution, performance management, and adherence to operational standards. - Coordinate with clinical and administrative departments to ensure complete and accurate documentation required for insurance approvals and claims processing. - Support audits and provide required insurance, claims, and financial documentation to internal and external stakeholders. - Prepare management reports, dashboards, and performance analysis related to the JHAH account. - Identify operational risks and escalate critical issues affecting revenue, claims, or contractual compliance to senior management. - Perform other duties related to insurance and revenue cycle management as assigned. Qualifications - Bachelor’s degree in Healthcare Administration, Health Information Management, Business Administration, Finance, Accounting, or a related field. - Professional certification in Healthcare Revenue Cycle Management, Medical Billing, or Insurance is preferred. - Knowledge of Saudi healthcare insurance regulations and payer requirements. - Strong knowledge of medical claims, pre-authorization, eligibility verification, denials management, and accounts receivable processes. Experience - Minimum 5–7 years of experience in healthcare insurance, revenue cycle management, medical billing, or claims management. - Proven experience managing hospital insurance operations and major healthcare payer accounts. - Experience with JHAH account requirements and processes is highly preferred. - Previous supervisory or managerial experience in a healthcare organization is required.

Manage the end-to-end insurance revenue cycle activities for the JHAH account, from eligibility and authorization through claims submission, reconciliation, and collection. Oversee insurance verification, eligibility checks, pre-authorizations, and approvals for inpatient, outpatient, emergency, and other healthcare services. Ensure accurate and timely submission of medical claims in accordance with JHAH contractual requirements and agreed billing procedures. Monitor claim status, outstanding receivables, rejected claims, and denied claims, ensuring timely resolution and follow-up. Analyze denial trends and identify root causes, implementing corrective actions to reduce claim rejection and improve revenue recovery. Ensure accurate coordination between Revenue Cycle Management, Medical Departments, Coding, Billing, Finance, and other relevant stakeholders. Maintain effective communication with JHAH representatives and relevant insurance stakeholders to resolve billing, authorization, and claims-related issues. Monitor account receivables and collection performance, providing regular reports and updates to senior management. Ensure compliance with contractual terms, payer policies, healthcare regulations, and internal policies and procedures. Review and monitor insurance-related KPIs, including authorization turnaround time, clean claim rate, denial rate, collection performance, and outstanding receivables. Develop and implement process improvements to enhance insurance operations, reduce revenue leakage, and improve cash flow. Lead, supervise, and develop the insurance team, ensuring appropriate workload distribution, performance management, and adherence to operational standards. Coordinate with clinical and administrative departments to ensure complete and accurate documentation required for insurance approvals and claims processing. Support audits and provide required insurance, claims, and financial documentation to internal and external stakeholders. Prepare management reports, dashboards, and performance analysis related to the JHAH account. Identify operational risks and escalate critical issues affecting revenue, claims, or contractual compliance to senior management. Perform other duties related to insurance and revenue cycle management as assigned.