o Understand and comply with network agreements between Insurance Companies and UHS.
Verifying the requests from doctors based on the medical conditions and determine whether requires preapproval.
Maintain record of approvals for requests that require approvals and update them frequently.
Processing claims in the system on daily basis (If required).
Auditing the invoices before sending to Insurance Companies.
Coordinating with Insurance Companies for queries related to medical approvals, claims etc
Reconciling the claims that are short paid/ rejected with valid medical reports.
Coordinating with doctors for medical reports and queries from Insurance Companies.
Liaise with patients and explain approval or rejection.
Undertake all calls regarding approvals from patients and provide appropriate replies.
Undertaking the approval and Insurance companies/sponsors as may be applicable.
Communicate with patient for approval/rejection status of approvals from sponsoring agency (including Insurance).
Communicate with Insurance companies/sponsors and provide required clarification/do follow up of cases.
Prepare cost estimate (if assigned) to be sent to insurance companies/sponsoring agencies.
Comply with jobs that are additionally assigned by manager from time to time.
Responsibilities
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Position Requirements/Qualifications
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Requirements/Qualifications
Bachelor Degree
2 years experience in health insurance.
Position criteria Other Skills/Abilities
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