Job Description
Job Purpose / Objective:
Responsible in monitoring all aspects of rejection & review invoices /patient medical files on daily basis, coordinating with insurance companies regarding issues related to claims, rejection and reconciliation
Key Responsibilities / Accountabilities:
- Monitor the rejection section and all aspects related to rejection and claims.
- Check & review invoices / patient medical files on daily basis, coordinating. With insurance companies regarding issues related to claims, rejection and reconciliation.
- Monitor the Claims Reviewer in reviewing claims & rejections.
- Prepare answer or justification for rejected claims.
- Prepares medical report as per requested by the insurance companies.
- Coordinate with physicians regarding re-explanation on rejected claims.
- Perform & complete of Reconciliation with Company & Hospital.
- Attend meeting for reconciliation along with the Business Service Manager.
- Provide information/orientation to all new doctors regarding Insurance Company and the all aspects of insurance policies.
- Analyse the rejections received from the insurance companies medically and administratively.
- Coordinate with the Claims Supervisor for any administrative rejections in order to improve the processing of the claims.
- Analyze the medical rejections and to coordinate with the concerned doctors / physicians for necessary orientation and guidance.
- Conduct quarterly presentation to the pharmacist.
- Provide insurance orientation to the doctors / physicians as per requested by the clinic.
- Participate in person-centered care initiatives undertaken by HMG.
- Enrich patient experience with compassion, respect and dignity.
- Perform other applicable task and duties assigned within the realm of his/her knowledge, skills and abilities.
Education/ Professional Qualification:
Experience:
- Medical insurance experience of 3-5 years
Professional Licensing / Certification / Training:
