Claims Supervisor

Dubai, United Arab Emirates

NMC Healthcare

424 Current Jobs Openings

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Job Description

In coordination with the Revenue Cycle Manager implements standard operating procedures and guidelines for the Insurance Preapprovals.
Obtaining on time authorizations for the facility as required by insurance companies and TPA\xe2\x80\x99s dependent upon the plan coverage for all patients.
Handling rejected preauthorization between the facility and the Insurance Companies.
Providing assistance, guidance and coaching support as needed to the team members.
Aligning approval team members performance expectations with organizational goals. Assess staff level and coordinates with Revenue Cycle Manager to meet defined KPIs. Providing fair, constructive, and timely feedback towards performance expectations and goals to the approval team.
Audit both IP and OP Insurance preapproval requests on a regular basis and share audit results with the team members and ensure that performance improvement plans are implemented

Ensures Insurance preapproval work is performed within the required technical and patient confidentiality standards.
Provides leadership and guidance to insurance Approval Team members and address their issues or concerns.
Act as a mentor and resource to Approval Team members.
Ensure that the Pre-Approval requests are submitted without any delay and followed up with the Insurance companies / TPA\xe2\x80\x99s in order to secure complete preapproval.
Respond to Insurance companies / TPA queries and liaise with concerned departments without any delay.
Responsible for receiving, evaluating and escalating second opinion cases and case management.
Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
Attend internal and external audits, meetings and give presentation when requested.
Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
Do scheduling of the insurance approval team to give sufficient insurance precertification coverage for the hospital. To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title. \\
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\xe2\x80\x99 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.