Submission Officer | Al Futtaim Health

Al Futtaim Private Company (LLC); Dubai; On-site; AED 50,000 - 90,000; Full time

Job summary

Al Futtaim Private Company (LLC) in Dubai is seeking a Billing & Claims Specialist to manage submission of IP, OP and Pharmacy claims with medical and technical justification. You will collaborate with physicians and insurers to ensure DHA-compliant submissions, reduce denials, and guide the billing team to optimize the revenue cycle.

Minimum 3 years in a similar role with certified coding and medical certificates is required.

Qualifications

• Certified professional coding certificate from a reputed institution.
• Certified medical/paramedical certificate.
• Minimum 3+ years’ experience in a similar role.

Responsibilities

• Submit IP, OP and Pharmacy claims with medical and technical justification.
• Follow up with branch on QMS issues.
• Interact with physicians for clinical justification of claims.
• Assist with IT support for complex cases requiring specialist knowledge.
• Coordinate with Insurance Approvals and Claims re-submission to minimize denials.
• Ensure submissions comply with DHA regulations and industry standards.
• Educate billing/Approval team to enhance process flow.
• Maintain accurate monthly data of claims submissions per insurer.
• Analyze revenue cycle data to identify defaulting payers and inform corrective actions.

Skills

Medical background

Negotiation skills

Soft skills

Education

Certified professional coding

Certified medical/paramedical certificate

Job description

• Ensure timely submissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.

• Internal Follow up for raised QMS to concerned branch.

• Interacting with the physicians for the clinical justification of the claims

• Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.

• Work closely with Insurance Approvals and Claims re-submission Team to minimize the claims denials

• Making sure that claim submissions are dealt with according to Insurance industry and DHA regulations.

• Comply with submission KPI’s (Key Performance Indicator) , maintain a record of submission KPIs as and when required.

• Educate billing/Approval team to enhance the process flow.

• Ensures that targets are met within turnaround time and while maintaining quality and productivity.

• Coordinate with CDI team to educate the physicians, and other paramedical team to ensure proper claims documentations.

• Maintain accurate monthly data of claims submissions of each insurance company

• Coordination with other business stakeholders to improve overall submission process efficiency.

• Analysis of financial data related to revenue cycle, to identify defaulting payers and work with the concern department on corrective strategies to mitigate the financial risk/s .

Desired Candidate Profile

Required skills to be successful:

Job-Specific Skills:

• Strong medical background to handle reconciliation efficiently.

• Strong Negotiation skills

• Strong soft skills

Behavioural Competencies:

• Excellent presentation and analytical skills

• Good decision-making skills

• Strong operational thinking skills

• Strong dedication skills

• Ability to work under pressure to achieve target

What qualifies you for the role:

Minimum Qualifications and Knowledge:

• Certified professional coding certificate from reputed institution

• Certified medical /paramedical certificate

Minimum Experience:

• Minimum 3+ years’ experience in a similar role. Proven experience in design and creative content development; strong track-record in translating creative ideas into visual displays