Ma. Gianne De Vera

* Reviews claims and finalizes for submission

* Sends Productivity reports on a daily basis

* Checks patient’s card validity, health plan and coverage

* Coordinates with Medical Coders for CPT, HCPCS, and ICD clarifications

* Follows up with Pre-Authorization Team regarding pending preapprovals and pending baby online numbers

* Coordinates with Medical Coders and Resubmission Team for the improvement of claim submission

* Calls patients to confirm visits and document the patient’s activities and their concerns from the last provider visit.

* Reviews medications and checks for pending laboratory results and communicate to the responsible team or department or the pending request of their providers. Note the patient’s problems and request for the upcoming visit.

* Reviews the patient’s chart and outlines patient concern prior to the provider visit with recommendations and documentation of the patient’s concerns.

* Assists with the provider’s order and communicate to the responsible department or team. This includes escalations and urgent assistance needed by the provider.

* Monitors the quality of service of the assigned provider by getting feedback from the patients, POA and facilities. Reviewing patients notes if complete and properly done.

* Sends prior authorization requests to Thiqa via OpenJet portal and accepts approvals.

* Confirms approved services to relevant staff members i.e. nurses, doctors etc.

* Coordinates with colleagues regarding queries from Thiqa and joins to investigate on rejections

* Files physical claim forms for safe keeping

* Sends inpatient and outpatient requests to Insurance Companies and at the same time accepts written and verbal approvals.

* Adheres to company policy and reports directly to the Revenue Cycle Management Director for daily tasks

* Understands UAE health regulations and payment policies under DOH regulation

* Develops complete knowledge of the payers accepted at Al Salama Group LLC

* Caters the insured patients

* Maintains the current contact list with payers call centers, customer service and authorization center

* Understands the basis of Health Insurance and basic definitions and equations

* Regularly updates the current policies and procedures of insurance companies as delegated by the Revenue Cycle Management Director

* Utilizes my medical knowledge and decision making ability to the insurance practice and gives solutions to the patients and doctors of Al Salama Hospital

* Completely adheres to the legal regulations of the authorization process and insurance practices

* Makes legitimate communication with the insurance companies through fax, emails and telephone

* Deals with clinical versus insurance issues confidently

* Coordinates between doctor, patient and insurers with problem-solving attitude or as situation demands

* Entertains queries related to policy coverage, limits and sub-limits

* Maintains good image and attitude towards hospital staff of all departments

* Always prepare and submit daily work reports to the Revenue Cycle Management Director

* Assists the director for any improvements or changes to be made in the processes

* Attends department meetings and responds to the evaluation tests and reports

* Disseminating circulars/memos from different Insurance Companies to concerned staff

* Conducts orientation to new hospital staff and refresher courses to update the existing staff’s knowledge on Insurance

* Assists in Insurance companies’ empanelment to Al Salama Group

* Assists the RCM Director in managing the Authorization Team’s daily productivity, attendance and a go-to person for prior authorization related issues.

* Serves as a liaison officer between the facility and multiple insurance companies through validation of correct information entered or written in different insurance claim forms, that is ICD-10-CM, CPT-4, IR-DRG and billed amount for the requested services, prior to submitting it via a secured system linked with various insurances.

* Approved pre-authorization requests are keenly verified for completeness and will be relayed to the healthcare provider. For denied or queried pre-authorization requests, medical justification or request to provide more reports will be coordinated with concerned provider or department.

* Comprehensively resubmits rejected claims and coordinates with the requesting clinician or professional to capitalize on it therefore increasing the revenue

* Coordinates with the claims department of different insurance companies and TPAs for clarification of rejections.

* Relays information to concerned staff regarding common rejections and finds a permanent solution.

* Fluent with clerical work

* Maintains strict confidentiality related to agreed tariffs with different insurance companies and medical records and insurance related information of the patients

* Responsible for Medical Insurance Staff schedules and timesheets. Prepares minutes of meeting, letters, memos, reports and circulars

* Medical history taking and Record keeping

* Vital signs taking

* Prepares exam rooms for use

* Monitoring supplies

* Sanitizing exam table and equipment between uses

* Administers vaccines with the doctor’s supervison

* Conducts skin tests

* Assists doctors on minor surgeries

* Encodes reports (laboratory and ultrasound reports)

* Sends out blood, blood products and tissues for laboratory testing

* Handles vaccines without breaking the cold chain

* Prepares specimen for laboratory reading

* Ensures that patients, especially kids, are comfortable while waiting for their turn

* Observes confidentiality

* Responsible for releasing laboratory and ultrasound results

* Reminds doctors of their schedule

* Logs used vaccines and supplies

* Troubleshoots software and hardware issues of desktops, laptops and tablets

* Makes appropriate charges for the needed troubleshooting

* Conducts Factory Reset and refresh to computers

* Updates drivers

* Creates tickets for hardware repairs

* Keeps track of laptops on repair

* Assists customer on purchasing computers and its accessories over the phone

* Provides list of Authorized Service Providers near the Customers area

* Coordinates with Level2 and Level3 technicians for third party software issues

* Transfers calls to appropriate queues

* Coordinates with third party technical support for wireless connection issues (i.e. ISPs)

* Escalates calls to Supervisor, Team Leader or Customer Relations Officers when needed

* Creates tickets for product recalls

* Provides Operating System help

* Gives basic information about new Operating System

Guiding Customers on initial laptop setup