Clinical Insurance Officer

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 recordsPrepare 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 correctionKeeping track of patients hospital admission ER visits and discharges.Prepare monthly report as Patient movement daman allocation admission and dischargeDaily 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 Nursing2 years experience in a similar roleAdvanced understanding of medical terminology and administration processesRemote Work : NoEmployment Type : Full-time Key Skills Data Entry,Customer Service,Accounting & Finance,Building Materials,Arabic Faculty Experience: years Vacancy: 1