Summary
Dallah Health is hiring an MOH Specialist in Riyadh to support hospital revenue cycle operations. The role manages insurance approvals for inpatient and outpatient care, follows up on pending requests, enters UCAF information in HMIS, and coordinates with contracted companies about referrals and treatment approvals. Applicants should have 1–3 years of relevant experience, knowledge of payer requirements and Saudi health insurance regulations, and practical experience using NPHIES. A bachelor's degree in a related field is required; CRCR, CHAA, or other relevant certifications are preferred.
The posting
As published on dallahhealth.com. Pulled from the employer's site and shown as they wrote it.
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