insurance claims processor

NMC Health plc

<div><p>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.</p></div>
<br><div><p>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.
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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.
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3.3 In the case of insurance claims, prepare the xml batch for the finalized claims and validate in the regulator&rsquo;s portal. Correct errors if any. In the case of corporate and individual payers prepare statement of claims for the period.
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3.4 In the case of Insurance claims, submit XML batches to regulator&rsquo;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.
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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.
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3.6 Ensure that the claims are appropriately dispatched by receiving the acknowledgement slip or verifying the regulatory post office with facility license number.
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3.7 Can prepare required monthly reports upon request.
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3.8 Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
</p><p>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
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3.10 Work accordance with the documented OSH procedures and instructions, specific responsibilities
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3.11 Be familiar with emergency and evacuation procedures
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3.12 Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports
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3.13 Comply with Waste management procedures and policies
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3.14 Attend applicable OSH/Infection control training programs, mock drills and awareness programs
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3.15 Use of appropriate personal protective equipment and safety systems
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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.
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3.17 Ensure implementation of applicable HAAD, NMCRH OSHMS and infection control policies and standards
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3.18 Ensure adequate budget and resources for FMS/OSH/PCI management.
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3.19 Designating a Safety facilitator who will be responsible for coordinating OSH activities within the department.
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3.20 Regularly discuss OSH issues or matters in departmental/ management meetings
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3.21 Ensure provision of OSH information, training and Supervision
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3.22 Implement and monitor effectiveness of risk management program</p></div>
<br><div><p>Bachelor of Commerce, Business Administration or any other degree. Paramedical or coding knowledge will be advantage.
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4.2 Two years minimum of experience.
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4.3 Knowledge of insurance billing procedure.
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4.4 Knowledge in using computer and related software applications.
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4.5 MS Office Experience, Word, Excel and Power point.
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4.6 Extreme organization skills.
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4.7 Communication, interpersonal skills as applied to interaction with co-workers, supervisor and customers</p></div>

Billing Officer

<div><ul><li><div><p>The Resubmission Officer will be responsible for filing and tracking insurance claims, process insurance and disability claims in a timely manner.
</p></div></li><li><div><p>Process the Resubmission of rejected claims on the system, follow up with respective doctors for justification if necessary and prepare them for resubmission.
</p></div></li><li><div><p>Ensure that all concerned teams such as Patient Admin staff, coders, doctors are updated on time with the rejections and corrective action is taken to avoid such instances in future.
</p></div></li><li><div><p>Submit the claims with proper codes and format to insurance companies within the stipulated time.</p></div></li></ul></div>
<br><div><ul><li><div><p>The Resubmission Officer will be responsible for filing and tracking insurance claims, process insurance and disability claims in a timely manner.
</p></div></li><li><div><p>Process the Resubmission of rejected claims on the system, follow up with respective doctors for justification if necessary and prepare them for resubmission.
</p></div></li><li><div><p>Ensure that all concerned teams such as Patient Admin staff, coders, doctors are updated on time with the rejections and corrective action is taken to avoid such instances in future.
</p></div></li><li><div><p>Submit the claims with proper codes and format to insurance companies within the stipulated time.</p></div></li></ul></div>
<br><div><p>Minimum of 1 years of experience in the Insurance Department.
</p><p>Knowledge of Claims Resubmission, Spreadsheets, and Software Modules.
</p><p>Skills in Current Procedural Terminology (CPT) Coding.
</p><p>Must have CPC certification</p></div>

Submission & Resubmission Officer

<div><p>3.1 Review and Audit Medical Claims to ensure their accuracy.
</p><p>3.2 Resubmission of rejected claims
</p><p>3.4 Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
</p><p>3.5 Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
</p><p>3.6 Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
</p><p>3.7 Submit the claims with proper codes and format to insurance companies within the stipulated time.</p></div><p></p>
<br><div><ul><li>Review and Audit Medical Claims to ensure their accuracy.
 </li><li>Resubmission of rejected claims
 </li><li>Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
 </li><li>Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
 </li><li>Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
 </li><li>Submit the claims with proper codes and format to insurance companies within the stipulated time.</li></ul></div>
<br><div><ul><li>Medical/Nursing graduate from a recognized university.
</li><li>Experience in Insurance Claims Resubmission
</li><li>Experience in Medical Coding is preferable.
</li><li>Excellent command of oral and written English.</li></ul></div>

Medical Auditor

ITCAN DENTAL CENTER

<p>Job Requirements &amp; Responsibilities:</p><ul><li>Verify patients&rsquo; insurance eligibility and coverage prior to treatment.</li><li>Obtain pre-approvals and pre-authorizations for procedures and services as required.</li><li>Submit insurance claims accurately and in a timely manner through the appropriate portals.</li><li>Follow up on pending, denied, or rejected claims and coordinate resubmissions or appeals.</li><li>Communicate with insurance companies, patients, and healthcare providers regarding claims and coverage issues.</li><li>Maintain accurate and organized records of claims, payments, and reimbursements.</li><li>Generate and submit periodic reports on claim status, revenue, and outstanding balances.</li><li>Proven experience in Hospital Insurance processes and coordination.</li><li>Handling insurance billing and reconciliation efficiently.</li><li>Expertise in insurance coding and related documentation.</li><li>Liaising and coordinating with insurance companies such as Al Koot Insurance, Glomed Insurance, QLM, Signa Insurance etc..</li><li>Ensuring accurate and timely processing of insurance claims and payments.</li><li>Maintaining comprehensive records and reports related to insurance activities.</li><li>Collaborating with accounts and other hospital departments to resolve insurance-related queries and issues.</li><li>Review and verify patient records, clinical notes, and charts for coding accuracy.</li><li>Ensure compliance with insurance policies, coding guidelines, and billing standards.</li><li>Identify and correct coding errors or discrepancies before claim submission.</li><li>Stay updated with current coding standards, payer requirements, and insurance rules.</li></ul><p><b>Application:</b></p><p>Send your latest CV/Resume, including educational background and working history</p><p>Job Type: Full-time</p><p>Pay: From QAR5,000.00 per month</p>

Insurance coder& coordinator

Judah Code Technologies

<p>Key Responsibilities:</p><ul><li>Review and process healthcare insurance claims in accordance with client guidelines.</li></ul><ul><li>Verify patient, provider, and claim details for completeness and accuracy.</li></ul><ul><li>Identify and resolve discrepancies or missing information in claims.</li></ul><ul><li>Ensure timely processing of claims to meet daily productivity and quality standards.</li></ul><ul><li>Handle claim denials, rejections, and resubmissions as per standard procedures.</li></ul><ul><li>Maintain proper documentation and update internal systems with claim status.</li></ul><ul><li>Collaborate with team leads or supervisors to address process issues or escalations.</li></ul><ul><li>Adhere to HIPAA and company data security policies at all times.</li></ul><ul><li>Participate in process improvement and quality assurance initiatives.</li></ul><p>Required Skills &amp; Qualifications:</p><ul><li>Bachelor&rsquo;s degree in any discipline.</li></ul><ul><li>0&ndash;3 years of experience in insurance claims processing (healthcare preferred).</li></ul><ul><li>Good understanding of US healthcare insurance concepts (CPT, ICD, HCPCS codes preferred).</li></ul><ul><li>Excellent written and verbal communication skills in English.</li></ul><ul><li>Strong analytical and problem-solving skills.</li></ul><ul><li>Basic computer knowledge with proficiency in MS Office (Excel, Word).</li></ul><ul><li>Ability to work night shifts and meet strict deadlines.</li></ul><p>Preferred Qualifications:</p><ul><li>Experience in claims adjudication, AR follow-up, or medical billing.</li></ul><ul><li>Knowledge of EOB (Explanation of Benefits) and healthcare claim life cycle.</li></ul><ul><li>Prior experience in BPO/KPO environments.</li></ul><p>Job Type: Full-time</p><p>Pay: &#8377;14,000.00 - &#8377;16,000.00 per month</p><p>Work Location: In person</p>

Process Associate Medical Billing

<p>Job Requirements &amp; Responsibilities:</p><ul><li>Review and verify patient records, clinical notes, and charts for coding accuracy.</li><li>Ensure compliance with insurance policies, coding guidelines, and billing standards.</li><li>Identify and correct coding errors or discrepancies before claim submission.</li><li>Stay updated with current coding standards, payer requirements, and insurance rules.</li><li>Proven experience in Medical Insurance processes and coordination.</li><li>Handling insurance billing and reconciliation efficiently.</li><li>Expertise in insurance coding and related documentation.</li><li>Liaising and coordinating with insurance companies such as Al Koot Insurance, Glomed Insurance, QLM, Signa Insurance etc..</li><li>Ensuring accurate and timely processing of insurance claims and payments.</li><li>Maintaining comprehensive records and reports related to insurance activities.</li><li>Collaborating with accounts and other hospital departments to resolve insurance-related queries and issues.</li></ul><p><b>Application:</b></p><p>Send your latest CV/Resume, including educational background and working history</p><p>Job Type: Full-time</p><p>Pay: From QAR5,000.00 per month</p>

insurance coder and coordinator

Fortune Motors Pvt Ltd

<p><b>Job description</b></p><ul><li>Handle and process <b>cashless claims</b> efficiently and within timelines.</li><li>Coordinate with <b>TPAs</b>, <b>insurance companies</b>, and internal departments for smooth processing of patient admissions and discharges.</li><li>Manage pre-authorisation, enhancement, and final approval processes for all cashless patients.</li><li>Ensure accurate and timely documentation for <b>CGHS</b>, <b>GIPSA</b>, and private insurance claims.</li><li>Track claim status, follow up on pending claims, and ensure timely reimbursements.</li><li>Maintain up-to-date records and MIS reports.</li><li>Coordinate with patients regarding insurance queries and documentation needs.</li><li>Ensure compliance with standard protocols and hospital policies</li><li>Should have experience in handling CGHS cases.</li><li>Approval for treatments regarding major emergency procedures / surgeries after discussing with HOD</li><li>Interaction with doctors regarding broad treatment plan vis--vis hospitalization expenditure Collecting of all letters</li><li>Clearances for Pharmacy / Procedures / Surgeries for IP corporates cases</li></ul><p><b>Requirements:</b></p><p>&middot; Minimum <b>2 years</b> of experience in hospital TPA operations, specifically with <b>CGHS</b>, <b>GIPSA</b>, and anywhere cashless networks.</p><p>&middot; Strong understanding of cashless claims and insurance processes.</p><p>&middot; Proficiency in <b>Microsoft Excel</b> &amp; hospital billing software.</p><p>&middot; Good communication and interpersonal skills.</p><p>&middot; Ability to work under pressure and handle multiple tasks</p><p>Job Type: Full-time</p><p>Pay: &#8377;8,691.98 - &#8377;38,824.21 per month</p><p>Benefits:</p><ul><li>Provident Fund</li></ul><p>Work Location: In person</p>

Sr Executive - Credit Billing

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