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Medical Insurance Specialist

3.00 to 5.00 Years   Riyadh, Saudi Arabia   10 May, 2023
Healthy Clinic
1 Jobs Openings
Job LocationRiyadh, Saudi Arabia
EducationBachelor's degree / higher diploma
SalaryNot Mentioned
IndustryMedical Clinic
Functional AreaNot Mentioned

Job Description

Reviews and adjudicates routine Medicare claims on HRP system in accordance with claim processing guidelines. Claims adjudication results should meet/exceed production and quality standards in line with CMS and Aetna compliance and business requirements.Responsibilities

  • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
  • Completes insurance verification on all new and existing patients and follow-up appropriately for authorization.
  • Contacts insurance carriers to obtain benefit coverage for ordered services, policy limitations, authorization/notification, and pre-certifications for patients.
  • Follows up with physician offices, customers, and third-party payers to complete the pre-certification process.
  • Requests authorization from insurance company case manager to provide specific services and parameters of care.
  • Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
  • Reviews the insurance verification and completes the authorization process within established time frames.
  • Enters data into software program accurately.
  • Maintains a thorough understanding of the revenue cycle which includes insurance requirements, billing, and associated correspondence and can independently resolve issues.
  • Scans and uploads appropriate documents to the patient chart and assists with completing patient profile.
  • Works closely with and supports team efforts to accomplish authorization/verification.
  • Participates in reimbursement, certification and authorization related activities as directed.
  • Documents payer and authorization information with the EMR system.
  • Completes Payor Change process, as needed.
  • Provides effective communication to team members, and other health care professionals and maintains confidentiality.
  • Attends all company training, when offered. Reports information systems security problems.
  • Maintain payor portals, notification of payor changes, etc.
  • Performs other duties as assigned.

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