About this role
- Review and Audit Medical Claims to ensure their accuracy.
- Resubmission of rejected claims.
- Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
- Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
- Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
- Submit the claims with proper codes and format to insurance companies within the stipulated time.
- Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
- Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements.
- Work accordance with the documented OSH procedures and instructions, specific responsibilities.
- Be familiar with emergency and evacuation procedures.
- Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports.
- Comply with Waste management procedures and policies.
- Attend applicable OSH/Infection control training programs, mock drills and awareness programs.
- Use of appropriate personal protective equipment and safety systems.
- Review and audit medical claims to ensure accuracy.
- Resubmission of rejected claims.
- Ensure that the agreed price list and provider manual from insurance companies are followed when billing services to the respective payers.
- Ensure that Billing Officers are updated on rejections in a timely manner and corrective actions are taken to avoid similar instances in the future.
- Handle the resubmission of rejected claims, follow up with respective doctors for claim justification, if necessary, and prepare claims for resubmission.
- Submit claims with proper codes and formats to insurance companies within the stipulated time.
- Perform any other jobs or duties assigned by the HOD from time to time within the scope of the job title.
- Comply with all OSH and infection control policies, standards and procedures, and cooperate with hospital management to meet these requirements.
- Work in accordance with documented OSH procedures, instructions and specific responsibilities.
- Notify OSH of hazards, incidents, near misses and issues, and assist with the preparation of risk assessments and incident reports.
- Comply with waste management procedures and policies.
- Attend applicable OSH/infection control training programmes, mock drills and awareness programmes.
- Use appropriate personal protective equipment and safety systems.
- Medical/Paramedical graduate (Nursing, Pharmacy, etc.) from a recognized university.
- Minimum 2 years of experience in Insurance Claims Management/Adjudication.
- Experience in Medical Coding is preferable.
- Excellent command of oral and written English.