Specialist - Submission (Tawam Fertility Center)

Responsibilities

• Monitoring compliance to insurance company's terms and conditions
• Monitoring compliance the rules and the contractual terms and agreement with the insurance companies
• Ensuring compliance by the facility pricing structure and the rules for the different patient categories (including self-payer) with implementation
• Assisting in collecting and processing claims
• Validating the claimed outpatient services (Laboratory, Radiology and Pharmaceuticals)
• Checking the claim invoices (inpatient and outpatient)
• Generating and regenerate the missed and incorrect invoices
• Processing each claim in the system
• Attending answering about financial matters, to patient and Specialty clinics inquiries  
• Preparing statement of accounts
• Following –up the claims submission to the insurance company
• Ensuring that all insurance documents been properly filled and claiming related amount
• Comparing the cancelled receipts received from cashiers on monthly basis to ensure that there are no manipulations in canceling transaction
• Resubmitting the rejected claims with a wrong reason or without reason and unpaid claims
• Providing customer service and support    Responding to verbal and written financial inquiries in a timely manner
• Providing technical expertise in identifying potential financial/Accounting issues
• Discussing with Manager/Senior Officer, if necessary, before recommending solutions after obtaining and verifying information
• Participating in cross-functional teams and committees as appropriate
• Serving as a subject matter expert in regards to inventory accounts, payments and accounting systems
• Developing and enhancing team procedure manual and processes and discussed with Manager/Senior Officer

Qualifications

Required: 
6 years of relevant progressive experience in a similar role 
Desired: 
Experience in a large healthcare facility