Responsible for processing, reviewing and filing governmental claims
Key Responsibilities / Accountabilities:
Process governmental claims in a timely manner to ensure prompt and full payment.
Review and verify governmental claims for completeness and accuracy.
Compile claims according to government specifications, i.e. claim forms, invoices, investigation results, prescriptions, etc.
Verify receipt of all invoices, medicine and clinical, received from Patient Services against HisGENx report on a daily basis.
Notify and follow up with Patient Services on daily basis any invoices, medicine and clinical, that were not received from Patient Services but are listed on HisGENx report.
Send monthly report to Patient Services Manager for any missing invoices, medicine and clinical, to ensure prompt and complete submission of company and insurance company claims.
Review medical records to clarify information and answer questions from companies and insurance companies.
Send letters on rejected claims and answers follow-ups on requests for information.
Receive and tally information on incomplete claims forms from assigned General Practitioner and forward to Director of Business Services for review and signature.
Send incomplete claims forms back to medical staff for response and follows up with medical staff to answer promptly.
Receive and send to medical staff any rejected claims requesting clarification or other information as requested by the companies and insurance companies.
Resubmit insurance claims that were rejected with appropriate responses to ensure prompt payment.
Oversee work of nursing staff temporarily assigned to assist Business Services in processing claims.
Photocopying, filing and faxing.
Participate in person-centered care initiatives undertaken by HMG.
Enrich patient experience with compassion, respect and dignity.
Perform other applicable tasks and duties assigned within the realm of his/her knowledge, skills and abilities.
Education/ Professional Qualification:
Bachelor’s Degree Business Administration or Commerce major in Accounting
Experience:
Minimum of 6 years experienced as an Accountant in Hospital Accounting
Experience and knowledge of Medical Insurance policies required
Minimum 5 years working experience as Claims Supervisor
Professional Licensing / Certification / Training:
