Subject Matter Expert - Health Insurance

Subject Matter Expert – Health Insurance

PHCC has a vision to be the leader in transforming the health and wellbeing of people’s lives in Qatar. PHCC’s mission is to deliver comprehensive, integrated and coordinated person‑centered health care services in the community through focusing on disease prevention, healthy lifestyles, and wellness. In partnership with our stakeholders, we will improve the health and wellbeing of our population.

The incumbent is primarily responsible in assisting the department with best value operational and insurance solutions, guiding in development of technical solutions, evaluating organizational needs and recommending required solutions. The incumbent shall also be required to oversee the development, testing, and implementation of various technical and operational processes.

• Support in developing, implementing, and maintaining operational requirements, including standard operating procedures, as well as databases, to manage and analyze programmatic information such as routine and ad‑hoc reports, deliverables, and programmatic documentation.
• Coordinate with teams and external audiences as needed to facilitate the implementation of successful transition strategies in coordination with Project manager.
• Support in effective delivery and technical direction for the implementation of primary care Electronic Medical Records (EMR) and Cerner Health Information Management solutions.
• Provide support and assistance in developing & implementing medical coding standards for Insurance.
• Development and implementation of RCM solutions for insurance.
• Assessing the effectiveness and efficiency of executing health insurance operations and making recommendations to be reviewed by relevant stakeholders.
• Guide and support relevant activities associated with changes, transition management, and new initiatives.
• Provide subject expertise and guidance to IT developers during the software development life cycle.
• Verifying technical reference information, including user guides, training manuals, and system requirements.
• Proactively manages and coordinates activities to ensure timeliness of deliverables to exceed contractual obligations in coordination with stakeholders.
• Monitor processes as directed to identify program vulnerabilities and ensure compliance with Health Insurance Payers agreements/contracts and all statutory, regulatory, and sub‑regulatory requirements are met.
• Ability to clearly communicate and exchange information with co‑workers, teammates, stakeholders, and other personnel, as required.
• Demonstrate proactive approach to patient safety by thinking what might go wrong in all your undertakings and take necessary measures to prevent them from happening.
• Identify and report potential or actual patient safety concerns, errors and/or near misses in timely manner.
• Follow patient safety‑related policies, procedures, and protocols.
• Demonstrate sense of teamwork and effective communication.
• Partner with line manager to understand risks in your area of work, develop a plan on how to mitigate those risks, and develop shared accountability for implementing and evaluating the plan.
• Working within PHCC may give access to knowledge of confidential matters which may include personal information of staff & patients.
• Such information must be considered strictly confidential and must not be discussed or disclosed.
• The incumbent will undertake any such related duties or responsibilities as directed.

Bachelor’s degree in business administration or management or a related stream.

• 7 years’ experience in Health Insurance in Healthcare Facility OR Healthcare Insurance Company.
• Knowledge of Microsoft applications including Word, Excel, PowerPoint and Project Management tools.
• Experience and understanding of revenue cycle processes and how business operations should be structured in a healthcare provider setting.
• Demonstrate ability to articulate revenue cycle operational requirements in clinical and administrative terms.
• Sound knowledge and experience in medical coding is added advantage.
• Cerner (Clinical Information system), myCARE & RCM experience is preferred.

Mid‑Senior level

Full‑time

Finance and Health Care Provider

Hospitals and Health Care