Job Description

Full job description

Profile :- Billing, Submission & Pre-Approval

Primary Responsibilities:

• Preapproval and Precertification for claims requiring approval.
• Monitoring and follow up on prior authorization for outpatient services.
• Evaluate the Pre-Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules.
• Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.
• Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution.
• Respond to Insurance/ TPA queries adequately and liaise with concerned department without any delay.
• Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
• Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
• Submission claims - XML file for all insurance companies in a timely fashion in line with claims adjudication rules of DHA
• Verify the ICD10 CM codes and relevant CPT/HCPCS codes on the claim forms for submission to various insurance companies on day-to-day basis.
• Responsible for the accurate flow of medical information and patient data between physicians, patients and third-party payers with the use of accurate numeric code to define diagnostics, treatments and procedures and to enter this information into the facility's database using medical coding protocol to produce a statement or claim.
• Coordinating with Insurance Doctors and Billing Supervisor/Accountants for E-claim Submission, Resubmission

Skills Required:

• Strong medical background to handle reconciliation efficiently.
• Good decision-making skills
• Ability to work under pressure to achieve target

Experience:

• Minimum 1+ years' experience in a similar role

Education:

• Medical or Nursing Background
• CPC Certification

Please upload your CV below or send it to hr@albayanmedicalcenter.com

Job Type: Full-time

Experience:

• Submission and Pre approval: 1 year (Required)

License/Certification:

• CPC Certification (Required)

Job Type: Full-time

Pay: AED2,500.00 - AED2,700.00 per month