Qureos Mentor

Fakeeh Care Group

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 Description
 
 
 
 Key Responsibilities and Duties: 1. Provide first- and second-level technical support for hardware, software, and network issues. 2. Respond to service requests via phone, email, ticketing system, or in-person. 3. Troubleshoot and support desktop and laptop computers, mobile devices, printers, and other peripherals. 4. Install, configure, and maintain software, hardware, and system updates. 5. Assist in IT asset tracking, inventory management, and equipment setup. 6. Document technical issues and solutions in the service desk knowledge base. 7. Escalate complex issues to senior IT staff or specialized teams as needed. 8. Assist with onboarding and offboarding tasks, including hardware deployment and account setup. 9. Continuously monitor the performance and availability of systems and networks to ensure efficient and effective operation. 10. Plan, test, and implement upgrades for information systems. 11. Integrate new software applications into existing systems. 12. Oversee and supervise system administrators, coordinating with different entities to ensure seamless operations. 13. Ensure new applications are integrated and deployed efficiently across the business. 14. Maintain up-to-date technical documentation, ensuring it is organized and accessible for future reference. 15. Develop and implement backup and disaster recovery procedures to safeguard data and systems. 16. Develop procedures to maintain security and protect systems from unauthorized use, natural disasters, and user abuse.17. Develop tools, procedures, and training sessions for Operations, Client Support, and Systems Development staff to assist with their work. 18. Install, configure, and maintain servers and data storage systems. 19. Mentor team members and educate users on system administration best practices. 20. Stay updated with emerging technologies and best practices in system administration to ensure continuous improvement. 21. Other duties as assigned within the scope of the job.
 
 
 
 Requirements
 
 
 
 Job Requirements Skills and Abilities: - Strong knowledge of system administration for complex operating systems. - Proficiency in designing, implementing, and maintaining mission-critical systems. - Expertise in monitoring system performance and availability. - Ability to develop and implement backup and disaster recovery procedures. - Strong problem-solving skills to address complex technical challenges. - Excellent documentation and organizational skills for maintaining technical records. - Leadership and mentoring skills to guide team members and educate users. - Knowledge of emerging technologies and best practices in system administration. Experience: IT Specialist: 0 - 2 years of experience in IT support or application support in a healthcare setting. Senior IT Specialist: Minimum of 3 years of experience in IT support or application support in a healthcare setting. Education: Bachelor's degree in Information Technology, Computer Science, or related field. Language: Excellent command of oral and written English and prefer Arabic. Licenses / Certifications: Preferred certifications: - CompTIA A+ - Held Desk Institute Support Center Analyst (HDI-SCA) - Certified Hardware Asset Management Professional (CHAMP) Certified IT Asset Manager (CITAM) Microsoft Certified: Modern Desktop Administrator Associate Project Management Professional (PMP) IT Infrastructure Library (ITIL)
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IT Specialist

<div>
 
 Description
 
 
 
 Key Responsibilities and Duties:
 
 
 <ul>
 <li>
 Ensure full adherence to the Council of Health Insurance (CHI) Preauthorization Policy, NPHIES standards, and
 
 
 </li>
 </ul>
 individual payer coverage protocols.
 
 
 <ul>
 <li>
 Prevent unauthorized, uncovered, or non-contracted services from being initiated.
 </li>
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 Support the implementation and compliance of NPHIES downtime contingency procedures.
 </li>
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 Verify the completeness of clinical documentation and utilization of the Minimum Data Set (MDS) for every
 
 
 </li>
 </ul>
 request.
 
 
 <ul>
 <li>
 Review the treating physician&rsquo;s progress notes, diagnostics, prescriptions, and clinical justifications for
 
 
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 </ul>
 accuracy and adequacy.
 
 
 <ul>
 <li>
 Validate medical necessity in alignment with evidence-based guidelines, CHI standards, and payer criteria.
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 <li>
 Ensure accurate clinical coding and scheme linkage to prevent claim denials.
 </li>
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 Escalate incomplete or inaccurate documentation for correction prior to submission.
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 Liaise with treating physicians, nurses, and roving doctors to secure approvals and clarify case details.
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 Communicate approvals, denials, and payer queries within CHI-mandated timelines.
 </li>
 <li>
 Respond to payer or insurer queries within 30 minutes of receipt.
 </li>
 <li>
 Escalate urgent or high-priority cases (ER, ICU, Oncology, or high-cost procedures) immediately to the
 
 
 </li>
 </ul>
 Preauthorization Manager.
 
 
 <ul>
 <li>
 Monitor HIS/NPHIES queues to follow up on pending or queried cases in real time.
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 <li>
 Maintain updated approval status in both HIS and the patient&rsquo;s record.
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 Ensure 100% completion of approvals for all discharges within the same day.
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 Confirm that same-day discharge and high-cost cases are fully approved prior to billing.
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 Document all approvals, denials, and payer communications in the patient&rsquo;s medical record.
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 Participate in the daily discharge reconciliation process and report pending approvals to the Preauthorization
 
 
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 </ul>
 Manager.
 
 
 <ul>
 <li>
 Review all preauthorization rejections received through NPHIES, payer portals, or HIS at least twice per shift.
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 Categorize rejections based on cause (missing justification, duplication, non-covered service, exceeded limit,
 
 
 </li>
 </ul>
 coding error, or late submission).
 
 
 <ul>
 <li>
 Record all rejections in the Rejection Tracker Log with patient MRN, preauthorization number, payer,
 
 
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 </ul>
 rejection reason, and physician name.
 
 
 <ul>
 <li>
 Coordinate with the Preauthorization Supervisor to ensure each rejection is reviewed and analyzed within the
 
 
 </li>
 </ul>
 assigned TAT.
 
 
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 <li>
 Engage directly with the treating physician for clarification or missing documentation related to rejected
 
 
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 </ul>
 cases.
 
 
 <ul>
 <li>
 Provide constructive feedback and guidance to physicians to avoid recurrence, referencing insurer
 
 
 </li>
 </ul>
 preauthorization protocols, CHI guidelines and NPHIES dataset requirements.
 
 
 <ul>
 <li>
 Conduct same-day briefings for rejections involving high-cost services.
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 Resubmit corrected documentation within the payer&rsquo;s appeal window as per the regulations.
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 Liaise with the insurance representative or roving doctor for urgent or high-priority resubmissions.
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 Confirm acknowledgment of resubmitted cases in both HIS and payer portals.
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 Identify root causes for all rejections and document corrective recommendations.
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 Distinguish between avoidable and non-avoidable rejections during end-of-day analysis.
 </li>
 <li>
 Submit a daily rejection summary to the Preauthorization Manager, covering:
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 <li>
 Total rejections received
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 <li>
 Avoidable vs non-avoidable ratio
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 <li>
 High-value or repetitive rejection patterns
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 Breakdown by payer, physician, and service category
 </li>
 <li>
 Recommend corrective actions such as MDS checklist updates, justification templates, or focused physician
 
 
 </li>
 </ul>
 sessions.
 
 
 <ul>
 <li>
 Collaborate with Fakeeh Tech to improve HIS alerts (e.g., auto-flagging incomplete documentation or
 
 
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 </ul>
 incorrect scheme linkage).
 
 
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 <li>
 Participate in weekly Preauthorization Group performance meetings to present rejection trends and lessons
 
 
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 </ul>
 learned.
 
 
 <ul>
 <li>
 Ensure complete transparency of all rejection cases to the Preauthorization Manager and Group
 
 
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 </ul>
 Preauthorization leadership.
 
 
 <ul>
 <li>
 Support the preparation of a Weekly Rejection Dashboard, including:
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 <li>
 Total rejection count
 </li>
 <li>
 Avoidable vs non-avoidable percentage
 </li>
 <li>
 Average approval turnaround time
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 <li>
 Top 10 contributing services, physicians, or payers
 </li>
 <li>
 Highlight immediate corrective actions taken and propose follow-up actions for recurring issues.
 </li>
 <li>
 Uphold professional communication standards and maintain formal documentation of all internal and
 
 
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 </ul>
 external correspondences.
 
 
 <ul>
 <li>
 Ensure continuous compliance with CHI, NPHIES, and contractual payer regulations in every stage of
 
 
 </li>
 </ul>
 preauthorization and rejection management.
 
 
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 <li>
 Report any non-compliance or process deviation to the Preauthorization Manager for immediate rectification
 
 
 </li>
 </ul>
 and inclusion in preauthorization Group review.
 
 
 <ul>
 <li>
 Other duties as assigned within the scope of responsibility and requirements of the job.
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 Experience: 3&ndash;5 years clinical practice, with at least 2 years in preauthorization/insurance or
 
 
 utilization management
 
 
 Education: Bachelor&rsquo;s degree in medicine and surgery, Pharmacy, Dental or related field.
 
 
 Language: Excellent command of oral and written English and Arabic.
 
 
 
 Licenses / Certifications
 
 
 
 Preferred license for practice as per the regional health regulatory authority e.g.
 
 
 (SCFHS / DHA).
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Approval Specialist

Join Fakeeh Care Group and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Fakeeh Care Group

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IT Specialist

Approval Specialist