Job closed
Ref: OP723-02
Job description / Role
The job holder will be accountable to process medical claims in a timely manner and has overall responsibility in auditing and reporting of outpatient reimbursement claims.
Key responsibilities are as follows:
- Maintain TAT and quality standards for Reimbursement claims processing
- Send electronic bordereau of the E- claims to the payers in order to inform them of approved claims and settlement amounts
- Prepare weekly and monthly processing reports for internal and external usage of information
- Answer provider/ insured members / PICs queries relating to claims processing, coverage limit inquires as and when required
- Train newly hired processors / PICs/Brokers/Insured Groups in reimbursment claims processing
- Review and audit the reimbursement claims processed in line with auditing guidelines and introduce innovative ways to minimize errors and enhance quality standards
- Analyse medical trends / utlilization rates and detect any fraud and abuse cases
Requirements
Minimum Qualifications:
- Graduate of any paramedical sciences
Minimum Experience:
- Minimum 3-4 years of experience in Reimbursement claims processing in insurance / TPA set up and prior experience in managing large teams will be a plus.
Job-Specific Knowledge & Skills:
- Knowledge relating to ICD -9/10, CPT
- Computer literate and excellent knowledge of Microsoft applications
- Excellent communication and interpersonal skills
- Good command of English language (Arabic knowledge is an added advantage)
About the Company
MedNet is a managed care service provider of quality solutions that meet an individual's long-term healthcare needs and offers financial protection against unforeseen health crisis and expenses. MedNet is dedicated to build long-term relationships with customers (insured members, insurance companies and other entities which require managed care services) by facilitating access to high quality and affordable managed care services.