Rejection can be separated into three categories: medical, financial & operational. Medical rejection should be forward to treating doctor (if needed) for explanation & justification of provided services. The Rejection analyst will maintain an Excel schedule showing the position of these justification requests at any given time. For financial & operational rejections: the analyst must obtain the necessary reports, results, justifications, etc. when all justifications and reports have been accumulated, they are entered onto the appeal summary Excel sheet & forwarded to the insurance company after reviewed by Rejection & Reconciliation manager.
Rejection and suspension details are maintained on Excel spreadsheets where they should be transferred into a defined data available for analysis.
Ensure that all insurance policies are available to be used as reference for rejection rules and regulations for review whenever needed.
Performs other tasks and duties within the scope of the knowledge skills and experience required for the job; as assigned by the immediate manager or department head.
Prepare improvement report based on rejections KPI by each department.
Provide personalized coordinated care, and support for staff and families.
Treat people with dignity, compassion, and respect.
QUALIFICATIONS:
Bachelor degree in medical related field.
PROFESSIONAL EXPERIENCE:
Minimum 2 years’ experience.
SPECIALIZED SKILLS :
skills and computer literate.
Excellent knowledge of English speaking & writing.
Updated knowledge of all insurance business, CCHI regulations.
