• Timely submissions of claims.

• Improve the quality of claims submission to achieve minimal initial denials

• Work closely with other stakeholders to apply securitizing rules to eliminate the technical denials and reduce the medical denial.

• The role also include stop revenue loss through monitoring and coordination with allconcerned stakeholders like preauthorization and coding team to facilitate timely closure of QMS related to claims coding clarification and codifications.

• Monitor behavioral payment of various payers and corporates to apply timely corrective action to mitigate the financial risk in claims submission

What you will do:

• Ensure timely submissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.

• Internal Follow up for raised QMS to concerned branch.

• Interacting with the physicians for the clinical justification of the claims

• Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.

• Work closely with Insurance Approvals and Claims re-submission Team to minimize the claims denials

• Making sure that claim submissions are dealt with according to Insurance industry and DHA regulations.

• Comply with submission KPI’s (Key Performance Indicator) , maintain a record of submission KPIs as and when required.

• Educate billing/Approval team to enhance the process flow.

• Ensures that targets are met within turnaround time and while maintaining quality and productivity.

• Coordinate with CDI team to educate the physicians, and other paramedical team to ensure proper claims documentations.

• Maintain accurate monthly data of claims submissions of each insurance company

• Coordination with other business stakeholders to improve overall submission process efficiency.

• Analysis of financial data related to revenue cycle, to identify defaulting payers and work with the concern department on corrective strategies to mitigate the financial risk/s .

Desired Candidate Profile

Required skills to be successful:

Job-Specific Skills:

• Strong medical background to handle reconciliation efficiently.

• Strong Negotiation skills

• Strong soft skills

Behavioural Competencies:

• Excellent presentation and analytical skills

• Good decision-making skills

• Strong operational thinking skills

• Strong dedication skills

• Ability to work under pressure to achieve target  

  
  

  Minimum Qualifications and Knowledge:

• Certified professional coding certificate from reputed institution

• Certified medical /paramedical certificate

Minimum Experience:

• Minimum 3+ years’ experience in a similar role. Proven experience in design and creative content development; strong track-record in translating creative ideas into visual displays