Team Lead - Resubmission & Reconciliation | Al Futtaim Health | Dubai, UAE

• Manage timely resubmissions of claims denials

• Monitor behavioural payment of various payors and corporates to apply timely corrective action to mitigate the financial risk.

• Improve the quality of claims resubmission to achieve minimal denials.

• Work closely with other stakeholders to eliminate the technical denials and reduce the medical denial.

• The role also includes stop revenue loss through monitoring and coordination with all concerned stakeholders like submission and preauthorization team to facilitate timely closure of quarterly, semi-annual, and annual reconciliations and signoffs with insurance companies and TPAs.as per regulatory terms.

• Facilitate and accelerate the early closures of QMS related to resubmission and reconciliation

• Interacting with the physicians for the clinical justification on the rejected claims

• Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.

• Working closely with Insurance Approvals and Claims Submission Team to minimize the claims denials

• Making sure that claim resubmissions are dealt with according to Insurance industry and DHA regulations.

• Ensure team' Compliance with re-submission KPI’s (Key Performance Indicator) , maintain a record of resubmission KPIs as and when required.
• manage timely resubmissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.

• Analyse the root cause for the denial by the various payers and collect timely feedback from other team members, create a special rules in the system to prevent the reoccurrence of those denials

• Educate billing/Approval team to enhance the process flow.

• Ensures that each member of recon team is meeting the daily resubmission target TAT while maintaining quality and productivity. Through continuous training

• Coordinate with Clinical Documentation team (CDI) to educate physicians, and other paramedical team to ensure proper claims documentations.

• Maintain accurate monthly data of claims resubmissions /reconciliations of each insurance company

• Highlight payment discrepancies by various payers to HOD knowledge.
• Bring payment discrepancies by various payers to HOD  knowledge.
• Coordination with other business stakeholders to improve overall resubmission /recon process efficiency.
• Analysis of financial data related to revenue cycle, to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risk
• Maintain a detailed statement of insurance denials segregated to technical denials and medical denials to facilitate the proper denial management plan and required training and documentation enhancement

Minimum Qualifications and Knowledge:

• Certified professional coding certificate from reputed institution

• Certified medical /paramedical certificate

• Minimum Experience:

• Minimum 4+ years’ experience in a leading resubmission leading role.

Job-Specific Skills: Key Skills:

• Strong medical background to handle reconciliation negotiation efficiently.

• Strong Negotiation skills

• Strong soft analysis skills 
• Strong relationship with the insurance companies

a)       Strong leadership and supervisory skills

b)      Conflict Management skills

                             c)       Excellent presentation and analytical skills

d)      Good decision-making skills

e)      Strong operational thinking skills

f) Critical Thinking skills.