Position Summary:
|
The Insurance Claims Specialist reflects the mission, vision,
and values of the organization, adheres to the organization’s Code of Ethics
and complies with all relevant policies, procedures, guidelines and all other
regulatory and accreditation standards. The Insurance Claims Specialist under the direction of the
Revenues Cycle Lead will be generally responsible for insurance claims
submissions and resubmissions (appeal) based on the agreed contract with each
payer in the region. Insurance Claims Specialist, Alfardan Medical Center,
Qatar |
Key Role Responsibilities:
The position holder will be responsible for the below:
|
SUBMISSIONS: ·
Reviews accuracy and
completeness of information requested and ensure that all supporting
documents are present ·
Receives requests for
pre-authorizations and ensure that they are properly and closely monitored ·
Consults with
supervisor or nurse manager to obtain clearance that treatment regimen is
considered a medical necessity ·
Processes referrals and
submit medical records to insurance carriers to expedite prior authorization
processes ·
Manages correspondence
with insurance companies, physicians, specialists and patients as required ·
Looks through denials
and submit appeals in a bid to get them approved from insurance companies ·
Creates patients’
records and accounts and ensure that pre-authorization information is
properly updated in them. ·
Secures patients’
demographics and medical information by using great discretion and ensuring
that all procedures are in sync. RESUBMISSIONS: ·
Checks and download the
XML Remittance Advice from payer and follow up for any missing remittance
advice. ·
Analyzes the rejection
from the XML remittance Advice. ·
ending the rejected
claims for the respected doctors for justifying the claims if necessary and
follow up with the doctors within the specified time ·
Prepares rejected
claims for resubmission ·
Makes sure that the
final rejection is at its minimal level. |
Qualifications, Experience and Skills:
|
Experience required: ·
1-2 years’ experience
in submission and Resubmission services at clinic or hospital facility in the
Region ·
Usage and Basic
Knowledge of (ICD 10 AM/CM with CPT and HCPCS) ·
Previous experience
with usage of medical terminologies. ·
Previous experience of
communication with all the payers /TPA in the region. Skills required: ·
Ability to project a
professional image, strong knowledge of regulatory standards and compliance
requirements, working knowledge of medical business office procedures and
basic accounting, and detailed understanding of ICD-10AM and CPT is important
for an individual wanting to work as a prior authorization specialist. ·
Follow up with
physician on queries related to medical necessity rejections ·
Maintains level of
efficiency in support of timely submission and resubmission deadlines. ·
Meets established
minimum productivity and quality standards for each claim. ·
Exceptional
interpersonal skills, including the ability to establish and maintain
effective relationships with patients, physicians, management, staff and
other customers. ·
Collaborate with other
departments to assist in obtaining pre-authorizations in a cross functional
manner, if required. ·
Excellent verbal and
written communication skills. ·
Excellent networking,
organizational and time management skills. ·
Experience working in a
multi-disciplinary team. ·
Exceptional
interpersonal skills, including the ability to establish and maintain
effective relationships with colleagues across all levels. ·
Demonstrated customer
service skills, including the ability to use appropriate judgment,
independent thinking and creativity when resolving customer issues. ·
Demonstrates attention
to detail and monitors own work for accuracy. ·
MS office and MS excel
skills required ·
Fluent English speaker.
Knowledge of Arabic will be an advantage although not essential. ·
Able to work in shifts,
weekends and on public holidays with extended hours based on work
requirements. |
Preferred Experience:
Understanding of healthcare industry preferred.
Skills required:
·
Excellent project management and organizational skills with
strong attention to detail.
·
Must have exceptional interpersonal skills with a strong
customer service orientation.
·
Highly motivated and proactive, with a “can-do” attitude.
·
Proven experience working in a team-oriented environment.
·
Strong computer skills with strong knowledge of Microsoft Office
suite
·
Works well in a fast-paced environment.
·
Customer Service orientation
·
Ability to organize and manage multiple assignments
·
Strong organizational, communication and interpersonal
skills.
·
Ability to follow directions independently.
·
Ability to communicate to a variety of internal and external
sources in a direct and professional manner.
·
Ability to participate and collaborate as a team player, working
in a time-pressured environment.
·
Fluent English speaker. Knowledge of Arabic will be an advantage
although not essential.
Essential:
·
1-2 years’ experience in the region in submission and
resubmissions.
Preferred:
Medical Graduation such as Nursing, Dentist, MBBS, Pharmacist or
Physiotherapist
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