Job Description

Roles & Responsibilities

Apply medical knowledge and best insurance practice while auditing / reviewing the claims prior submission, medical records and other documentation essential to justify the services rendered to the patient by the healthcare facility.
Ensure that the details of the claims are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules
Apply medical knowledge and best insurance practice while auditing / reviewing the claims prior submission, medical records and other documentation essential to justify the services rendered to the patient by the healthcare facility.
Ensure that the details of the claims are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
Handling resubmission of rejected claims.
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 those requirements
Work 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 assistance with the preparation of risk assessments, incident reports
Comply with Waste management procedures and policies
Attend applicable OSH/Infection control training programs, mock drills and awareness programs
Use of appropriate personal protective equipment and safety system

Desired Candidate Profile

Qualifications

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.

Medical Auditor NMC healthcare LLC

Qualifications