Job Description

Ensures that credit patient accounts are opened for every out & inpatient receiving care at Dallah Hospital should have an approval, and maintain this al in an orderly timely manner.

• Supporting the organization’s revenue cycle objectives through efficient approval and authorization processes
• Ensuring compliance with payer policies, contractual requirements, and internal procedures
• Contributing to timely service delivery by preventing approval-related delays
• Promoting accuracy, accountability, and transparency in approval workflows
• Safeguarding organizational revenue by minimizing authorization-related denials
  
• Enter the UCAF information in HMIS.
• Follow up all pending approval request for in-patient & out-patient and assure that company approval is granted for all services.
• Contact companies who have contracts with the hospital with relation to referral and approval of treatment.
• Provides information to patient concerning covered services and approval requirements under their company health plan.
• Assure that all inpatient hospitalized within the approval limit.
• Fully aware and actively implement the departmental policies and procedures, local and international standards or requirements related to the department
• Actively involves in indicator development, data collection for the department and to measure the performance of the function, process, and outcome.  Whenever required, conducts analysis and interpretation of data/information collected
• Participate in hospital Safety Management & Risk Management Programs. Actively reports incidents in the system and whenever needed, participates in incident review, and root cause analysis.
• Performs any other duties within the range of his/her competence, as directed by the Revenue Cycle Director.

Requirements

• 1-3 years of experience in healthcare revenue cycle, insurance approvals, or patient access
• Strong understanding of insurance authorization processes and payer requirements
• Experience working with hospital information systems and approval platforms
• Familiarity with healthcare reimbursement and claim submission processes
• Experience in a hospital or healthcare provider setting is preferred
• Practical experience using NPHIES platform for eligibility, pre-authorization, and approvals
• Strong understanding of CCHI insurance policies, benefit structures, and compliance requirements
• Experience handling approvals for inpatient, outpatient, and high-cost procedures under CCHI
• Familiarity with Saudi healthcare insurance regulations and payer contractual requirements
  
  
  
• achelor’s degree in Health Administration, Business Administration, Healthcare Management, or related field.
• Certified Revenue Cycle Representative (CRCR) (Preferred)
• Certified Healthcare Access Associate (CHAA) (Preferred)
• Relevant insurance or revenue cycle certifications (Preferred