Job Description
Roles & Responsibilities
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 with those requirements.
Work in 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 assist with the preparation of risk assessments and incident reports.
Comply with waste management procedures and policies.
Attend applicable OSH/infection control training programs, mock drills and awareness programs.
Use appropriate personal protective equipment and safety systems.
Ensure that employees follow applicable OSH/infection control policies, procedures and standards.
Provide OSH information, training and supervision to staff.
Report any OSH-related incidents, near misses, and hazards in the department in a timely manner.
Ensure that incident corrective actions have been implemented.
Assist with preparation of risk assessments and monitoring control measures.
Ensure trainings are conducted, including general/departmental/FMS/OSH orientation for new employees and transferred employees, refresher training for department staff, etc.
Desired Candidate Profile
Medical/paramedical (nursing, pharmacy, etc.) graduate from a recognized university.
Experience in insurance claims management/adjudication (minimum 2 years).
Experience in medical coding is preferable.
Excellent command of oral and written English.