Rejection Officer - Eastern Province, المملكة العربية السعودية - Almoosa Specialist Hospital

وصف

JOB DESCRIPTION

Duties and Responsibilities:

• Rejection can be separated into three categories: medical, financial & operational. Medical rejection should be forward to treating doctor (if needed) for explanation & justification of provided services. The Rejection analyst will maintain an Excel schedule showing the position of these justification requests at any given time. For financial & operational rejections: the analyst must obtain the necessary reports, results, justifications, etc. when all justifications and reports have been accumulated, they are entered onto the appeal summary Excel sheet & forwarded to the insurance company after reviewed by Rejection manager
• Rejection and suspension details are maintained on Excel spreadsheets where they should be transferred into a defined data available for analysis.
• Ensure that all insurance policies are available to be used as reference for rejection rules and regulations for review whenever needed.
• Performs other tasks and duties within the scope of the knowledge skills and experience required for the job as assigned by the immediate manager or department head.
• Prepare improvement report based on rejections KPI by each department.

QUALIFICATIONS:

• Bachelor degree in medical related field.

PROFESSIONAL EXPERIENCE:

• Minimum 2 years' experience.

SPECIALIZED SKILLS :

• skills and computer literate.
• Excellent knowledge of English speaking & writing.
• Updated knowledge of all insurance business, CCHI regulations.

COMPETENCE:

• Good command of both English and Arabic spoken & written
• Computers & analytics skills.
• Performs all tasks under pressure.
• Proper, effective and compassionate communication.
• Good interpersonal and communication skills.
• Organized and able to work methodically.
• Presentable, pleasing personality with a professional attitude as well as confident and enthusiastic.
• Pro-active and able to successfully prioritize competing priorities.