Insurance Officer (In-patient and Out-patient claims) - Healthpoint Hospital - Zayed sport city, Abu Dhabi, UAE
(2013-01)
- Preparing and analyzing monthly batches for submissions
- Verifying and pointing out errors if any
- Meting insurance KPI and completing tasks prior to deadlines
- Providing lists for updating expired Drugs code
- Verification of medical aspects of all claims
- Making sure proper billing has been done as per service rendered
- Generating and uploading final verified claims batches to HAAD
- Following mandatory HAAD guidelines
- Performing audit of randomly selected claims to ensure quality processing
- Taking necessary step to generate more Revenue
- 24hours claim submission from encounter date
- Preparing monthly submission records
- Performing resubmission according to denial reasons, corrections and internal complaint
- Maintaining low rejection rate through eliminating rejection possibilities from initial submission
- Uploading claims within the timeframe to avoid TIME-001 rejections
- Submitting IP and DAYCASE claims and making sure all the service codes are billed and according to approval obtained
Medical Insurance Claim Officer (In-patient claims) - Gulf Diagnostic Center Hospital - Al Khaleej al Arab St., Abu Dhabi, UAE
(2010-01 - 2013-12)
- Processing direct billing medical claims following the procedure and in accordance with the terms & conditions of the HAAD policies
- Preparing cost estimation breakdown for all DRG and Day cases prior to pre Authorization
- Revising the cost calculations breakdown encase of CPT procedure is changed by the doctor and then resending for authorization
- Billing through system after surgeries are performed and raising invoices
- Following the guidelines of insurance companies for exclusion
- Submission of In-patient xml files to HAAD through Globis in house messenger on monthly basis
- Preparing In-patient summary report on monthly basis
- Keeping proper tracking of surgeries performed by coordinating with In patient department
- Meeting the deadline of claim submissions
- Entering claims data into system
- Providing timely reports to billing and accounts department
- Performing audit of randomly selected claims to ensure quality processing
- Excellent understanding of medical terminology
- Coordinating with the Insurance Staff to ensure that all necessary information is checked for accuracy and compliance with contract discount
- Checking claims prepared for accuracy as per agreement, prior to dispatch to respective insurance companies
- Liaise with treating physicians to receive properly completed claim form requests for services, which require approvals as per policy terms and conditions
- Monitoring the daily admission and discharge process for obtaining a list of admitted patients
Medical Insurance Claim Officer (out-patient claims) - Gulf Diagnostic Center Hospital - Al Khaleej al Arab St., Abu Dhabi, UAE
(2009-01 - 2010-12)
- Responsible for preparing all medical insurance claims and submitting it to insurance companies
- Checking and encoding E claims and then compiling the files to submit it to insurance companies
- Making monthly summary reports
- Submission of claims to HADD through Greenrain messenger, Expert in error corrections
- Meeting the time criteria for submission
- Manage routine daily claims administration work
- Evaluating claims with regards to eligibility
- Coordinate work flow & meet deadlines
- Attending calls and e-mails from insurance companies, clients, and providers
- Making suggestions to improve service
- Increasing efficiency, minimizing errors and administration time
