Financial Counselling and Authorization Officer-Financial Counselling and Authorization

Financial Counselling and Authorization Officer - Financial Counselling and Authorization

Sheikh Shakhbout Medical City - SSMC Posted Mar 6 Full-time Negotiable Unknown

JOB DESCRIPTION

Responsible for obtaining authorization approvals whenever required under the following conditions:

• Daman and contracted insurance as per the policy terms and conditions.
• Non contracted insurance by communicating guaranty of payment.

The role holder manages insurance liability and fund reallocation for rejected services under the ABM policy and attends to patient self pay estimation when needed. The job holder communicates efficiently with internal and external stakeholders to finalize patient authorization requests and is responsible for counseling self pay patients, collecting pre payments, and managing outstanding balances according to established collection procedures.

RESPONSIBILITIES

• Receive and adjudicate approval requests through agreed communication channels.
• Conduct initial assessment of approval requests and collaborate internally to ensure all required documents/data from the clinical/coding side are complete and accurate.
• Communicate with payers via official channels (emails, payer portals, E authorization in house system) once documents are complete.
• Maintain correspondence with insurance companies, physicians, coding, and patients in case of authorization denials to resolve queries.
• Log and update all assigned requests in the productivity tracking sheet.
• Follow up on pending approvals to ensure timely processing.
• Receive and communicate approvals/GOPs internally as per agreed processes.
• Verify approvals/GOPs match requested services (DRG-CPTs, drugs, HCPCS).
• Obtain re authorization revisions per regulator rules.
• Escalate delayed cases and report to the escalation matrix.
• Maintain and update insurance records such as eligibility, medical reports, treatment plans, and claim amounts.
• Prepare and provide self pay data reports for senior management review.
• Log information accurately in the HIS and billing system.
• Demonstrate customer focus when interacting with stakeholders.
• Analyze medical reports and insurance regulations to provide relevant inputs.
• Liaise with Medical Records and finance staff for coding and billing purposes.
• Identify and contact self pay patients to verify insurance status and coverage.
• Assist self pay patients across the hospital, including ER and inpatient locations, regarding responsibility, payment ability, and financial assistance options.
• Ensure completion of clearance processes for current day and next day patients.
• Liaise with case managers and discharge teams on patient issues involving insurance implications.
• Develop affordable payment plans for self pay patients.
• Gather information required to process financial assistance requests.
• Facilitate and register Guarantee of Payment (GOP) letters and provide approvals for treatment.
• Maintain patient statements of account on GOP letters with limits and approve treatment when required.
• Prepare updated statements of account regarding charity deposits and approve treatment when required.
• Monitor and follow up on GOP revisions related to incorrect DOA, facility name, amount, or service.
• Assist patients seeking assistance for outstanding claims, issuance of receipts, and charity applications.
• Complete necessary paperwork promptly.
• Coordinate with external resources (e.g., Red Crescent) to secure payment for medical care.
• Monitor, maintain, analyze, and update financial reports to ensure all accounts remain acceptable.
• Collect estimated liability documents from patients.
• Remain in constant contact with patients, review their insurance benefits, and provide alternative solutions.
• Communicate financial coverage status and decisions to patients, families, and referring clinicians.
• Comply with relevant rules, regulations, policies, and procedures.
• Perform other duties as assigned.

ACCOUNTABILITIES

• Collect and maintain estimated liabilities from patients.
• Establish and manage health insurance benefits, conditions, and requirements via phone inquiries, eligibility systems, and the Internet.
• Maintain patients' employment details and other particulars.

QUALIFICATIONS

Experience:

• 2 4 years of relevant experience.
• Experience in a large healthcare facility (desired).

Educational Qualification:

• Diploma in Accounting/Finance/Commerce or related field.
• Bachelor's degree or equivalent in Accounting/Finance/Commerce or related field (desired).

ABOUT US

At SSMC, we firmly believe that the human touch is a fundamental part of care. We understand that health care is both an art and a science, running deeper than simply diagnosing and treating those who rely on us. Our SSMC Model of Care puts our patients at the forefront of our purpose and at the heart of everything we do, ensuring that the needs of our patients come first. Every one of our patients receives individualized attention from a multidisciplinary team of experts who collaborate closely to deliver trusted and compassionate care. From the very first point of contact with SSMC, to the moment patients are back home, we ensure speciality specific care at every stage and in every interaction. As one of the largest tertiary hospitals in the UAE, SSMC provides access to specialist medical treatments and advanced diagnostics, with a commitment to becoming a Destination Medical Center in the UAE and wider region.

ABOUT THE TEAM

Sheikh Shakhbout Medical City (SSMC) is the largest tertiary hospital in the UAE and serves to elevate the provision of health care services in the nation under the mandate of the Abu Dhabi Economic Vision 2030. Supported by the latest diagnostic and treatment modalities available, SSMC offers care in 44 specialties. A team of locally and internationally trained medical, clinical and admin professionals work seamlessly together, promoting comprehensive interdisciplinary learning, allowing SSMC to become a leading hub for integrated patient centric medical services in the region. As the region's leading tertiary facility, SSMC has 742 patient beds, 18 operating theatres, a hybrid operating room, a 26 bed neonatal intensive care unit, and the UAE's largest pathology lab.

ABOUT THE COMPANY

Sheikh Shakhbout Medical City - SSMC