- Monitoring compliance to insurance company's terms and conditions
- Monitoring compliance the rules and the contractual terms and agreement with the insurance companies
- Ensuring compliance by the facility pricing structure and the rules for the different patient categories (including self-payer) with implementation
- Assisting in collecting and processing claims
- Validating the claimed outpatient services (Laboratory, Radiology and Pharmaceuticals)
- Checking the claim invoices (inpatient and outpatient)
- Generating and regenerate the missed and incorrect invoices
- Processing each claim in the system
- Attending answering about financial matters, to patient and Specialty clinics inquiries
- Preparing statement of accounts
- Following –up the claims submission to the insurance company
- Ensuring that all insurance documents been properly filled and claiming related amount
- Comparing the cancelled receipts received from cashiers on monthly basis to ensure that there are no manipulations in canceling transaction
- Resubmitting the rejected claims with a wrong reason or without reason and unpaid claims
- Providing customer service and support Responding to verbal and written financial inquiries in a timely manner
- Providing technical expertise in identifying potential financial/Accounting issues
- Discussing with Manager/Senior Officer, if necessary, before recommending solutions after obtaining and verifying information
- Participating in cross-functional teams and committees as appropriate
- Serving as a subject matter expert in regards to inventory accounts, payments and accounting systems
- Developing and enhancing team procedure manual and processes and discussed with Manager/Senior Officer
Required:
6 years of relevant progressive experience in a similar role
Desired:
Experience in a large healthcare facility
