Financial Counselling and Authorization Officer-Financial Counselling and Authorization

Responsibilities

• Responsible for obtaining authorization approvals whenever needed in the following conditions: Daman and contracted insurance as per policy terms and conditions; Non-Contracted insurance by communicating guaranty of payment.
• Manage insurance liability and fund reallocation for the rejected services under the ABM policy; attend to patient self-pay estimation when needed.
• Communicate efficiently with internal and external stakeholders to finalize patients' authorization requests.
• Counsel self-pay patients, collect pre-payments and outstanding balances following established collection procedures.
• Receive and adjudicate approval requests through agreed communication channels; coordinate initial assessment with clinical/coding teams to ensure documents/data are complete and accurate.
• Facilitate communication with payers through official channels (emails, payers portals, in-house authorization system) once documents are complete.
• Manage all correspondence with insurance companies, physicians, coding and patients in case of authorization denials to address insurance queries.
• Log and update all assigned requests in the productivity tracking system; follow up on pending approvals to obtain timely decisions.
• Ensure approvals/GOPs are received and communicated internally as per the agreed process; verify that approvals match the requested services (DRG, CPTs, Drugs, HCPCS).
• Obtain necessary reauthorization revisions as per regulatory rules.
• Prepare and follow the escalation matrix to report delayed cases due to external factors.
• Maintain and update documents and insurance records (eligibility, medical reports, treatment plans, claim amounts, etc.).
• Prepare self-pay data reports for review by senior management; document information in the HIS and billing system accurately to ensure patient information is updated.
• Demonstrate customer focus when interacting with internal or external stakeholders; analyze medical records and insurance regulations to provide relevant inputs to concerned parties.
• Liaise with Medical Records staff for coding and with finance staff for billing purposes.
• Determine self-pay patient lists and contact patients or sponsors to verify insurance status and coverage.
• Manage self-pay patient visits throughout the hospital (ER and inpatient) to discuss patient responsibility, ability to pay, and availability of financial assistance.
• Ensure clearance for current-day and next-day patients; liaise with case managers and discharging teams on 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; maintain copies and provide approval for treatment if required.
• Maintain patient statement of account on GOP letters with limits and provide approval for treatment if required.
• Prepare updated Statement of Account regarding Charity Deposits and provide approval for treatment if required.
• Monitor and follow up GOP revisions for incorrect DOA/facility name/amount/service details.
• Assist patients seeking assistance for outstanding claims, issue receipts, and process Charity applications.
• Complete all necessary paperwork in a timely manner; coordinate with outside resources (e.g., Red Crescent) to secure payment for medical care.
• Monitor and analyze financial reports to ensure patient accounts are maintained appropriately; collect estimated liability documents from patients.
• Stay in contact with patients to review insurance benefits and offer alternative solutions; communicate financial coverage status and decisions with 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 by making phone inquiries and using eligibility systems and the internet.
• Maintain patients' employment details and other particulars.

Qualifications

Experience

Required: 2-4 years of relevant experience

Desired: Experience in a large healthcare facility

Educational Qualification

Required: Diploma in Accounting/Finance/Commerce or relevant field

Desired: Bachelor's degree or equivalent in Accounting/Finance/Commerce or relevant field

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 specialist-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

About Sheikh Shakhbout Medical City (SSMC): 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, which promotes 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, and includes a hybrid operating room, 26-bed neonatal intensive care unit, and the UAE's largest pathology lab.