About Our Client:
The Ministry of National Guard Health Affairs (MNGHA) in Saudi Arabia is a premier healthcare organization providing high-quality medical care to National Guard soldiers, employees, and their families. MNGHA operates several hospitals and medical cities across the Kingdom, offering specialized services, advanced medical technologies, and comprehensive patient care.
Job Description:
Evaluate and process claims in accordance with insurance policy, terms and conditions and MNGHA policies and procedures. Review medical reports and ensure proper entry and compatibility with the services provided by the hospital. • Check the accuracy of medical information with supporting documents (i.e. Laboratory, Pharmaceutical, Radiology, etc.). Communicate with the treating physician/medical team for any clarification or completion of missing information. • Escalate pending cases to the concerned department and follow-up directly with Medical Services. Coordinate and follow-up with the approving officer/s discrepancies in the official form. • Collaborate with the claims section team on clinical queries/requests to re-assess the claims. Develop billing system to improve Revenue Cycle Management (RCM) and decrease the number of rejections. Report any observations related to claims that may affect the RCM. • Facilitate the reconciliation process, respond to rejected claims with proper justifications in accordance with the insurance requirements and coordinate with the insurance companies for resubmission in a timely manner. • Participate in establishing, developing and implementing guidelines to evaluate and process medical claims. • Collect sufficient information for each issue and escalate it to the concerned department. Provide professional advice to subordinates on all aspects of medical insurance practice and law. Assume the responsibilities of Claims Analyst as and if required. • Prepare and present necessary reports and correspondences as required by the Executive Management and Senior Executive Management.
• Perform other job related duties.
Education:
Bachelor Degree in Medicine or equivalent from an accredited institution
Completed HIMAA, ICD-10-AM/ACHI/ACS – Introductory Course
Experience:
Minimum of 4 (four) years position-related experience or processor/auditor of insurance claims in similar health institution or insurance company
Certifications & Other Requirements:
Preferred Nationality:
Sudani, European, Middle East
Salary & Other Benefits:
As part of the benefits package, MNGHA offers a tax-free salary, along with additional perks such as accommodation, transportation, medical coverage, and bonus schemes upon contract completion.
Benefits of Working in the Middle East:
• Tax-Free Salaries: Most Middle Eastern countries do not impose income tax, allowing employees to enjoy their full earnings. • Free Flights: Employers offer free annual return flights to the employee’s home country. • Paid Annual Leave: Hospitals often provide ample annual paid leave, allowing employees to enjoy extended breaks and time off. • Free Medical Care: Healthcare benefits, including access to high-quality medical care, are often provided by employers. • Accommodation: Hospitals offer free or subsidized housing, reducing living expenses significantly. • Transport: Hospital provide free or subsidized transport, making commuting more convenient and cost-effective. Life Style in Saudi Arabia For many who have worked in Saudi Arabia, they have had the e
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