Financial Counselling and Authorization Officer

Sheikh Shakhbout Medical City

Manages to receive and adjudicate approval requests through the agreed communication channels.

Coordinates to do initial assessment of the approval request and do the needed internal collaboration to ensure all the needed documents/data from the clinical/coding Side are complete and accurate.

Facilitates once documents are complete communicate with the payers through the official communication channels (emails-Payers Portals, E authorization in-house system).

Manages all correspondence with insurance companies, physicians, coding and patients in case of authorization denials to ensure clearing the insurance queries accordingly.

Ensures logging and updating all assigned requests in the productivity tracking sheet.

Coordinates to have a proper follow up on the pending to obtain a timely manner approvals.

Ensures receiving and communicating approvals/GOPs internally as per the agreed process.

Oversees that approvals/GOPs are correct and matching the requested services (DRG-CPTS- Drugs, HCPCs).

Ensures obtaining the needed reauthorization revisions as per the regulators rules.

Prepares and follow process escalation matrix to report delayed cases due to any external factors.

Maintains and updates documents and insurance records such as eligibility, medical reports, treatment plan, claim amounts etc.

Prepares reports as required on self-pay data for review by the senior management

Documents information in the HIS and billing system completely and accurately in order to ensure that the respective patient information is updated.

Demonstrates customer focus when interacting with internal or external stakeholders.

Analyses documents such as medical reports and insurance regulations and providing the relevant inputs from same to the concerned parties

Liaises with the Medical Records staff for coding and finance staff for billing purposes.

Determines to self-pay patient lists and call patients and/or their sponsors to check their insurance status and coverages.

Manages visits self-pay patients throughout the hospital including, Emergency Room (ER) and Inpatient locations to discuss patient responsibility, ability to pay, availability of financial assistance.

Assures completing clearance process of current-day patients, next-day patients

Liaises with case managers and discharging team on patient issues with insurance implications

Develops affordable payment plans for self-pay patients.

Gathers all relevant information required to process financial assistance request.

Facilitates and registers Guarantee of Payment (GOP) letters; maintains a copy of the Letter and provides Approval for treatment if required.

Maintains patient statement of account on GOP letters with limits and provides approval for treatment if required.

Prepares updated Statement of Account re: Charity Deposits, and provides Approval for treatment if required

Monitors and Follow-up GOP revision required with regards to wrong DOA/Facility name/Amount/Service

Assists patients seeking assistance for outstanding claims, issuance of receipts, and Charity applications.

Completes all necessary paperwork in a timely manner.

Coordinates with outside resources (Red Crescent) to secure payment for medical care.

Monitors, maintain, analyze and update the financial reports of the patients to ensure all the accounts are maintained at acceptable.

Collects estimated liability documents from patients.

Assists and remain in constant touch with patients, to review their insurance benefits, and provide them with alternative solutions.

Communicates financial coverage status and applicable financial decisions with all appropriate parties: patient , family , referring clinicians

Complies with relevant rules, regulations, policies , and procedures

Performs other duties as assigned.

Accountabilities

• Collects and maintains estimated liabilities from patients.
• Establishes and takes charge of health insurance benefits, conditions, and requirements by making phone inquiries, and by using eligibility systems and the internet.
• Maintains patients employment details and other particulars