Insurance Approval \ Claim (RCM)

Role Overview :

Play a key role in streamlining our financial operations as a Revenue Cycle Management (RCM) Specialist, guaranteeing accurate and timely billing, coding and claims submission. This position has a direct impact on our center's capacity to deliver high-quality patient care and is essential to its financial stability. In order to maximize revenue capture and ensure compliance with all regulatory standards, you will be in charge of doing the many phases of the revenue cycle, from insurance verification to claim processing, and rejection management.

Key Job Responsibilities :

• Verify patient demographic and insurance information for accuracy and completeness at the point of registration.
• Confirm patient eligibility, benefits, and pre-authorization requirements with insurance providers for all oncology and hematology services.
• Prepare, review, and submit accurate and timely medical claims to various insurance companies using appropriate coding.
• Ensure all claims comply with payer-specific guidelines, coding regulations, and CHI standards and Saudi Coding system.
• Monitor claim status and resolve any issues that may delay payment.
• Analyze rejected claims to identify root causes and implement corrective actions.
• Prepare and submit effective appeals to insurance companies for rejection claims, providing necessary documentation and justification.
• Track rejection trends and report findings to the Revenue Cycle Manager to improve future claim submission processes.
• Stay updated on changes in healthcare regulations, coding guidelines, and payer policies to ensure continuous compliance.
• Generate reports on revenue cycle performance, including key metrics such as days in A / R, denial rates, and collection rates.
• Identify opportunities for process improvement to enhance efficiency and revenue capture.
• Collaborate closely with clinical staff, coding specialists, finance department and customer services teams to ensure accurate documentation and smooth information flow throughout the revenue cycle.
• Participate in team meetings and contribute to discussions on revenue cycle optimization strategies.

Job Requirements :