Job Description

Eye Consultants is dedicated to delivering exceptional eye care services with compassion and excellence. We are seeking a friendly, organized, and proactive Customer Service Representative to join our team and ensure a seamless and positive experience for our patients.

Key Responsibilities: Patient Insurance Profile Management

• Update patient insurance details (network, policy, co-payment) in the HIS.
• Monitor billing encounter types (billable vs. non-billable) and ensure accurate charge capturing.
• Coordinate with reception when patients are not eligible for direct billing, ensuring patient liability (self-pay/reimbursement) is communicated before consultation.
• Prepare and hand over completed claim forms to the nursing department after explaining service coverage.
• Create Electronic Medication Requests via the E-claim portal and update covered/non-covered drugs as required.
• Ensure original signed claim forms (as per DHA consent signature criteria) are collected for payer audit compliance.
• Review daily billing and revenue reports, making same-day invoice corrections when required.
• Process patient sick leave requests.

Daily Approval Processing & Tracking

• Process consultation and investigation approvals according to payer-specific outpatient prior authorization protocols (optical limits, OP limits, etc.).
• Handle Outpatient/Daycase Surgery approvals upon confirmation from doctors/nursing team.
• Maintain a maximum 24-hour Turnaround Time (TAT) for approval submissions (subject to document availability).
• Track and document delays in surgery requests for internal coordination.
• Communicate approval, rejection, or pending status to internal teams for timely scheduling.
• Coordinate with affiliated labs for required preoperative investigations.
• Follow up on pending approvals and obtain additional documentation when required.
• Request physician clarification using the standard PQF (Physician Query Form) in compliance with (AHIMA) Query Protocol.

Claims Processing – Submission

• Prepare claim templates and maintain accurate insurance claim databases.
• Collect and verify supporting documents for submission.

Payment Tracking – Resubmission & Reconciliation

• Monitor remittances (payments and rejections) through the DHPO portal.
• Track payments received per claim and coordinate with the Finance Department for reconciliation and statement of accounts.

Key Responsibilities:

• Minimum 4 years of experience in medical insurance coordination and coding in the UAE.
• Strong understanding of DHA regulations, e-claims, and payer protocols.
• Experience in approvals, resubmissions, denial management, and reconciliation.
• Excellent communication and coordination skills.
• High attention to detail and ability to work within strict TATs.
• Coding certificate.