King's College

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<td>Pre-Authorization Approval Processing and Turnaround - Facilitate securing service approvals from patients’ insurance companies - Ensure approvals meet the agreed turnaround time (outpatient within 24 hours; inpatient within 24–48 hours) - Send all approval requests on the same day - Escalate cases that exceed the agreed turnaround time to the Pre-Authorization Supervisor Communication and Documentation - Review and release all approvals (e-mail or RHES) to the respective clinic - Prepare cost estimates for insurance and cash patients Tracking and Data Management - Maintain an up-to-date Approval Request Tracker and save it in the shared folder - Maintain an updated Insurance Master, share it with internal stakeholders, and save it in the shared folder. Training and Stakeholder Support - Assist the Pre-Authorization Team Lead in delivering training on insurance policies and procedures to internal stakeholders (patient administration, nurses, doctors) - Support providing updates on insurance policies and procedures (via email or in-person sessions) to internal stakeholders. Escalation and Issue Reporting - Report issues or discrepancies to the Pre-Authorization Team Lead (for example, insurance policy clarifications or information technology infrastructure concerns) Coordination and Work Practices - Complete assigned tasks in coordination with the supervisor or manager - Demonstrate flexibility to work in shifts and during public holidays Claims Operations Claim Submission and Billing Operations - Responsible for claim submission for all facilities (Dubai Hills, Jumeirah, and Marina) or as assigned to the employee. - Lead electronic billing and assign tasks to dispatch staff - Prepare and generate Extensible Markup Language files and troubleshoot in the electronic claim system - Ensure timely, high-quality dispatch of physical and electronic invoices to accelerate payments and reduce rejections - Coordinate with insurance companies on electronic billing and submission matters Coding and Tariff Integrity - Identify discrepancies in Current Procedural Terminology, Healthcare Common Procedure Coding System, and tariffs; escalate to the Revenue Cycle Management Assistant Manager – Claims Operations. Review, Screening, and Issue Resolution - Conduct daily screening and review of insurance claim forms and related documents for completeness - Review claims flagged with issues by the claims team and escalate to the concerned team (for example, the Prior Authorization team). Reporting and Monitoring - Prepare weekly under-dispatch reports for outpatient and pharmacy - Monitor and audit the claim-submission vendor and escalate performance issues to the Revenue Cycle Management Assistant Manager – Claims Operations. Cross-Functional Coordination - Coordinate with laboratory, pharmacy, front office, and hospital branches to ensure smooth workflow. Training and Development - Train and onboard new claims staff for outpatient submission Payer Relations Payer Network Management &amp; Coordination - Support the execution of payer onboarding and credentialing processes, ensuring compliance with payer requirements and regulatory standards. - Maintain and update the hospital’s insurance network matrix and payer participation status. - Coordinate internal documentation required for network agreements, renewals, and re-credentialing (licenses, accreditations, etc.). - Assist in preparing and submitting network application documents and forms. - Track contract status and follow up on expirations, renewals, and pending network approvals with insurance partners Tariff &amp; Contract Maintenance - Assist in maintaining a centralized and up-to-date tariff repository, including historical versions. - Support in tariff revision calculations and tracking. - Coordination with billing teams for the maintenance of Cash Price lists, and liaising with Payers for their updated price lists. - Maintain logs of contract terms, exclusions, special agreements, and validity dates. Stakeholder Liaison &amp; Communication - Act as the first point of contact for internal departments (billing, front office, insurance desk) seeking clarification on network participation and contract inclusions. - Coordinate with RCM, Finance, Legal, and Clinical teams to ensure timely response to insurance and corporate queries. - Schedule and document meetings, conference calls, and contract discussions with payers and corporate partners. Reporting &amp; Documentation - Maintain logs, dashboards, and trackers for ongoing payer-related activities. - Assist in preparing reports and summaries for senior management on network coverage, contracting progress, and risk areas. - File and manage digital copies of all contracts, credentialing materials, and correspondence in a structured and auditable manner. 1. JCIA-Aligned Safety, Quality, Governance and Professional Standards - Support sustainability and Global Health Impact (GHI) goals by practising environmentally responsible behaviour, reducing waste, following proper disposal and segregation processes, using resources efficiently, participating in related training, and reporting opportunities for improvement. - Follow all safety, quality, infection-control awareness and risk-management procedures; report safety events and near misses; participate in workplace violence-prevention training; and escalate concerns using approved communication tools such as Situation–Background–Assessment–Recommendation (SBAR). - Participate in emergency drills (fire, major incidents, communicable diseases and pandemics) and understand assigned roles during emergencies. - Maintain all required competencies, credentials and training required for the role, and work strictly within the authorised scope of responsibilities. - Complete documentation accurately and on time according to hospital and Joint Commission International Accreditation (JCIA) standards, and maintain confidentiality of patient, staff and organisational information. - Identify and report environmental hazards or unsafe equipment, follow equipment-safety guidelines and report malfunctions promptly. - Use hospital information systems safely, protect passwords and confidential data, comply with cybersecurity and data-protection policies, and report suspicious IT-security incidents. - Respect and protect patient rights, dignity, cultural preferences, privacy and confidentiality, and communicate with patients, colleagues and visitors in a clear and culturally sensitive manner. - Maintain ethical behaviour, professionalism, integrity and respectful interactions with colleagues, patients and visitors. - Participate in audits, quality-improvement activities and performance reviews to support continuous organisational improvement. - Follow all relevant hospital policies, procedures and JCIA-related standards applicable to the role. 2. Organisational Responsibilities. - Perform any additional duties reasonably assigned by the organization or line manager, even if not explicitly listed in this job description, to meet operational needs and support specific objectives of your department and organization - Comply with all organizational and departmental policies, procedures, legal requirements, and applicable regulations at all times, and take personal responsibility to read, understand, follow and keep updated with the latest versions. - Avoid and report any actions that may cause financial loss, reputational damage, or breach of trust to the organization, including fraud, dishonesty, or misrepresentation, which may result in disciplinary action, termination, and legal liability. - Maintain confidentiality of all organizational, patient, client, and employee information in accordance with policies and laws.</td>
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RCM Coordinator (Emirati National)

RCM Coordinator (Emirati National)

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