أخصائي MOH

Ensures that credit patient accounts are opened for every out & inpatient receiving care at Dallah Hospital should have an approval, and maintain this al in an orderly timely manner.

• Supporting the organization’s revenue cycle objectives through efficient approval and authorization processes

• Ensuring compliance with payer policies, contractual requirements, and internal procedures

• Contributing to timely service delivery by preventing approval-related delays

• Promoting accuracy, accountability, and transparency in approval workflows

• Safeguarding organizational revenue by minimizing authorization-related denials

• Enter the UCAF information in HMIS.

• Follow up all pending approval request for in-patient & out-patient and assure that company approval is granted for all services.

• Contact companies who have contracts with the hospital with relation to referral and approval of treatment.

• Provides information to patient concerning covered services and approval requirements under their company health plan.

• Assure that all inpatient hospitalized within the approval limit.

• Fully aware and actively implement the departmental policies and procedures, local and international standards or requirements related to the department

• Actively involves in indicator development, data collection for the department and to measure the performance of the function, process, and outcome. Whenever required, conducts analysis and interpretation of data/information collected

• Participate in hospital Safety Management & Risk Management Programs. Actively reports incidents in the system and whenever needed, participates in incident review, and root cause analysis.

• Performs any other duties within the range of his/her competence, as directed by the Revenue Cycle Director.

Requirements

• 1-3 years of experience in healthcare revenue cycle, insurance approvals, or patient access

• Strong understanding of insurance authorization processes and payer requirements

• Experience working with hospital information systems and approval platforms

• Familiarity with healthcare reimbursement and claim submission processes

• Experience in a hospital or healthcare provider setting is preferred

• Practical experience using NPHIES platform for eligibility, pre-authorization, and approvals

• Strong understanding of CCHI insurance policies, benefit structures, and compliance requirements

• Experience handling approvals for inpatient, outpatient, and high-cost procedures under CCHI

• Familiarity with Saudi healthcare insurance regulations and payer contractual requirements

• achelor’s degree in Health Administration, Business Administration, Healthcare Management, or related field.

• Certified Revenue Cycle Representative (CRCR) (Preferred)

• Certified Healthcare Access Associate (CHAA) (Preferred)

• Relevant insurance or revenue cycle certifications (Preferred