Job Summary:
GluCare Integrated Diabetes Center is seeking a highly organized and detail-oriented Insurance Coordinator to join our team. The Insurance Coordinator will be responsible for managing the insurance processes, including pre-approvals, claims submissions, resubmissions, and reconciliations. The role requires a thorough understanding of insurance policies, regulations, and healthcare billing systems. The ideal candidate will work closely with healthcare providers, patients, and insurance companies to ensure the smooth processing of claims and maximize revenue recovery.
Key Responsibilities:
- Pre-Approval Coordination: Ensure all required pre-approvals for treatments and procedures are obtained from insurance providers in a timely manner.
- Claims Submission: Prepare and submit insurance claims in compliance with payer policies and regulations, ensuring accuracy and completeness.
- Resubmissions & Appeals: Handle rejected or denied claims by identifying errors or missing information and resubmitting or appealing claims as necessary.
- Invoicing: Generate accurate invoices for patients and insurance companies, ensuring alignment with policy coverage and patient treatment plans.
- Verification of Insurance Coverage: Check and verify patient insurance coverage and eligibility before services are provided, ensuring that the required services are covered under the patient's policy.
- Reconciliation of Accounts: Work with the finance department to reconcile patient accounts, ensure payments are posted correctly, and identify any outstanding balances.
- Patient Support: Provide clear communication and support to patients regarding insurance coverage, claims status, and any financial obligations they may have.
- Maintaining Records: Keep detailed and organized records of all insurance-related documents, claims submissions, payments, and correspondence.
- Liaison with Insurance Providers: Maintain strong working relationships with insurance companies, ensuring quick resolution of issues related to claims or approvals.
- Compliance: Ensure that all insurance activities are in compliance with DHA (Dubai Health Authority) regulations and other relevant healthcare insurance standards in the UAE.
- Regular Reporting: Provide regular reports on claim submissions, approvals, denials, and reimbursements to management for review and action.
Understand, follow and support all hospital infection control programs
Requirements
- A Bachelor's degree in healthcare administration, business administration, or a related field is preferred.
- Certified Professional Coder (CPC) Certified
- Minimum of 2 years of experience in medical insurance coordination, claims processing, or healthcare billing within a healthcare facility or insurance company.
- Experience in an endocrinology clinic will be an added advantage
- Familiarity with UAE healthcare insurance regulations, insurance provider policies, and DHA standards. In-depth knowledge of coding systems such as ICD-10 and CPT codes is highly desirable.
- Strong expertise in:
- Approvals
- Invoicing
- Submissions and resubmissions
- Eclaimlink and DHA regulations
- Solid understanding of medical terminology and clinical justifications
- Excellent communication skills, both verbal and written, to interact with insurance companies, patients, and healthcare providers.
- Proficiency in healthcare billing software and systems.
- Ability to analyze, prioritize, and solve issues related to insurance claims and denials.
- Time management skills to handle multiple tasks and meet deadlines.
- Language: Fluency in English is required. Proficiency in Arabic is an advantage.
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