Clinical Insurance Officer at Ghobash Group

Abu Dhabi, Abu Dhabi Emirate, United Arab Emirates -

Full Time

Start Date

Immediate

Expiry Date

11 Jan, 26

Salary

0.0

Posted On

13 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Management, Patient Eligibility Verification, Claim Documentation, Medical Terminology, Clinical Coordination, Authorization Tracking, Documentation Review, Report Preparation, Communication Skills, Attention to Detail, Problem Solving, Team Collaboration, Regulatory Compliance, Patient Care, Data Collection, KPI Reporting

Industry

Investment Management

Description

Company Description Pyramids Health Services has been offering experienced home care services by specialized medical professionals in the UAE since 2012. PHS has been awarded with the highest level of accreditation in Long Term and Home Care by CARF (Commission on the Accreditation of Rehabilitation Facilities) International on 2017. Our wide range of services extend beyond basic home nursing to specialized physiotherapy and medical care in all situations providing short-term or long-term care in the home, depending on a person’s needs. We are qualified to source and operate medical equipment approved from referring hospitals and customized for the home setting and deliver safe ad smooth transitions. Job Description Summary: The Clinical Insurance Officer is responsible for managing all insurance-related processes for home healthcare patients, including pre-authorizations, renewals, and claim documentation. The role ensures that all clinical and administrative requirements are met in compliance with payer guidelines, Department of Health (DOH) standards, and internal policies. Roles & Responsibilities: Obtain, monitor, and renew insurance pre-authorizations for all homecare services (e.g., nursing, physiotherapy, medical, and multidisciplinary care). Verify patient insurance eligibility and coverage before initiating or renewing services. Coordinate with insurance companies and third-party administrators (TPAs) to secure approvals and address pending or rejected requests. Liaise with physicians and clinical staff to complete and submit all required medical reports and treatment plans. Ensure all insurance forms including DAMAN Forms (PAFs, progress notes, medical reports) are properly signed, stamped, and compliant with DOH and payer requirements. Track authorization validity to prevent service interruptions for active patients. Score medical condition and services for new and established patients. Follow up with insurance company regarding required reports or information. Determining the correct codes for patient records Prepare all reports and documents required by insurance company to grant pre-approval as (collection and arrange the reports, face to face, consent form, license of nurses, physiotherapy & Doctor, nursing care plan, physiotherapy plan and assessment, Scoring grid) Review clinical documentation to ensure it supports medical necessity for services billed to insurance. Verify that patient records, including Periodic Assessment Forms (PAFs) and treatment notes, align with the approved authorization scope and duration. Identify incomplete or inconsistent documentation and coordinate with clinicians for prompt correction Keeping track of patients hospital admission, ER visits and discharges. Prepare monthly report as Patient movement, daman allocation, admission and discharge Daily submission of staff capacity to daman. Prepare and submit JAWDA KPI report and act as JAWDA KPI data collector. Collect and save all KPI reports. Perform other duties as assigned by management.. Qualifications Bachelor of Nursing 2+ years’ experience in a similar role Advanced understanding of medical terminology and administration processes

Responsibilities

The Clinical Insurance Officer manages all insurance-related processes for home healthcare patients, ensuring compliance with payer guidelines and internal policies. This includes obtaining pre-authorizations, verifying insurance eligibility, and coordinating with insurance companies and clinical staff.