Medical Claims Supervisor
MEAHCO - Saudi German Health
Multiple Vacancies
Posted 30+ days ago
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Nationality
Any Nationality
Gender
Not Mentioned
Vacancy
3 Vacancies
Job Description
Roles & Responsibilities
- Manage central account activities' execution to ensure that all billing, payments, contracts, accruals, and related transactions are treated appropriately according to internal and statutory controls and the agreed terms with third-party.
- Conduct studies related to the average cost per claim across the Hospital and income breakdown and ensure that they align with the SGH studies and agreed pricing.
- Monitor rejection rates, identify common issues and work on developing appropriate plans to decrease rejection rates.
- implement accounting and financial reporting systems to provide accurate and timely consolidated reports related to insurance amounts standings to meet the needs of SGH and facilitate follow-up activities.
- Manage all the claim activities, within the Hospital, review unprocessed and denied claims and ensure compliance with the agreed framework to ensure revenue optimization.
- Monitor RCM Specialist claims activity collection and ensure execution as per agreed terms and timing with the insurance.
- Review all the reports related to AR (Total Sum, Days outstanding, AR per company), bad debts expense, etc. Work with RCM Manager on developing action plans to ensure financial equilibrium for SGH.
- Ensure that proper customer service related to billing and collection is delivered for all the patients.
- Ensure that all billing and preauthorization information is executed optimally and entered accurately to the system and comply with CCHI justification rules on the claim processing.
- Manage all the claim activities, within the Hospital, review unprocessed and denied claims and ensure compliance with the agreed framework to ensure revenue optimization
Desired Candidate Profile
- Not less That 4 to 5 years of experience in Medical Claims
- Not less than 1 year experience in Supervisor Position
- Medicine Graduates is highly preferred
- High level of leadership and Communication Skills
- Experience with KSA Market will be an Asset
- Ex health insurance companies or Hospitals is mandatory
Company Industry
- Medical
- Healthcare
- Diagnostics
- Medical Devices
Department / Functional Area
- Insurance
- Underwriting
- Surveying
- Actuary
Keywords
- Medical Claims Supervisor
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MEAHCO - Saudi German Health