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Officer Reconciliations - Network

1.00 to 10.00 Years   Muscat, Oman   08 Apr, 2022
MedNet Oman (MN-OMN) BU
1 Jobs Openings
Job LocationMuscat, Oman
EducationNot Mentioned
SalaryNot Mentioned
IndustryOther Business Support Services
Functional AreaNot Mentioned

Job Description

For MedNet Oman (MNSPC)As a member of Munich Re the MedNet Oman is one of the leading managed care service organizations that caters to healthcare needs. We are currently seeking to hire an Omani National as an ?Officer Reconciliations ? Network? based in Oman. He / She will conduct and manage Reconciliations of claims, monitor KPIs, audit and report claim and sign the closure letter with the providers.Your Job:

  • Maintain TAT of resubmission claims and reconciliation closures as per regulatory guidelines and other KPIs set by the management.
  • Conduct financial reconciliations with providers in order to match provider and MN records.
  • Calculation of reconciliation reserves.
  • Conduct providers reconciliation closures in line with internal guidelines
  • Ensure account closure letter to providers for closure of accounts is recorded.
  • Answering provider, via phone calls and emails, regarding resubmission claims processing, outstanding claims, and any other inquiries to provide them with clarifications where needed.
  • Review and audit the resubmission claims processed by following the auditing criteria, guidelines and applying the high costs authority matrix when needed.
  • Report Fraud and abuse cases and analyzing provider claims trend and report to Medical Reviewer/Recon doctor.
  • Organize, attend, and document meetings with internal and external stakeholders.
  • Consistently, efficiently, and effectively work to achieve daily targets and various initiatives.
Your profile:
  • Bachelor?s degree (Paramedic) or Diploma in Hospital Administration / Allied healthcare sciences like Physiotherapy, Nursing, Radiology or Laboratory technician.
  • CPT and DRG coding knowledge and certification preferable.
  • Minimum 1-3 years of experience in Reconciliation claims in health insurance industry.
  • Analytical and Logical thinking ability - Job demands analysing information and using logic to address work related issues.
  • Computer literate and excellent knowledge of Microsoft applications in particular excel is must.
  • Excellent communication, negotiation, presentation, and interpersonal skills
  • Good command of written and spoken English language.
  • Good planning, execution and conflict solving skills.
  • Strong teamwork and collaboration skills. .
  • Must have an eye for quality and be a systematic thinker
Minimum Qualifications:
  • Bachelor?s degree (Paramedic) or Diploma in Hospital Administration / Allied healthcare sciences like Physiotherapy, Nursing, Radiology or Laboratory technician.
  • CPT and DRG coding knowledge and certification preferable.
Minimum Experience:
  • Minimum 1-3 years of experience in Reconciliation claims in health insurance industry.
*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.

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