Billing Officer

Checks and compiles ALL Insurance claims before submitting them to respective payers and insurance companies using coded data to finalize and submit claims to insurance companies.

Verify the items in the open bills according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, rate plan etc. Ensure that the bills are finalized in compliance with the contractual terms and price agreement.
3.2 Finalize all codified credit bills for batch/statement generation based on the submission cycle (eg, weekly, monthly etc). In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc and confirm the bill.
3.3 In the case of insurance claims, prepare the xml batch for the finalized claims and validate in the regulator’s portal. Correct errors if any. In the case of corporate and individual payers prepare statement of claims for the period.
3.4 In the case of Insurance claims, submit XML batches to regulator’s portal (eg. greenrain messenger). In the case of corporate and individual payers, dispatch the claims with all documents attached and dispatched with a manual acknowledgement slip.
3.5 In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc.
3.6 Ensure that the claims are appropriately dispatched by receiving the acknowledgement slip or verifying the regulatory post office with facility license number.
3.7 Can prepare required monthly reports upon request.
3.8 Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title

3.9 Comply with all OSH (Occupational safety and health )and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements
3.10 Work accordance with the documented OSH procedures and instructions, specific responsibilities
3.11 Be familiar with emergency and evacuation procedures
3.12 Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports
3.13 Comply with Waste management procedures and policies
3.14 Attend applicable OSH/Infection control training programs, mock drills and awareness programs
3.15 Use of appropriate personal protective equipment and safety systems
3.16 Ensure as far as reasonably practicable that any workplaces they manage or control are safe and without risks to health, safety or the environment.
3.17 Ensure implementation of applicable HAAD, NMCRH OSHMS and infection control policies and standards
3.18 Ensure adequate budget and resources for FMS/OSH/PCI management.
3.19 Designating a Safety facilitator who will be responsible for coordinating OSH activities within the department.
3.20 Regularly discuss OSH issues or matters in departmental/ management meetings
3.21 Ensure provision of OSH information, training and Supervision
3.22 Implement and monitor effectiveness of risk management program

Bachelor of Commerce, Business Administration or any other degree. Paramedical or coding knowledge will be advantage.
4.2 Two years minimum of experience.
4.3 Knowledge of insurance billing procedure.
4.4 Knowledge in using computer and related software applications.
4.5 MS Office Experience, Word, Excel and Power point.
4.6 Extreme organization skills.
4.7 Communication, interpersonal skills as applied to interaction with co-workers, supervisor and customers