Claims Adjuster (Reimbursement Unit)

Al Ahly Medical Company - Giza, Giza

121
Applicants for
1 open position
88
Seen
1
Shortlisted
1
Rejected
Experience Needed:
1 to 2 years
Career Level:
Entry Level
Job Type:
Full Time
Salary:
Confidential
Vacancies:
1 open position
About the Job
  • Conduct regular random samples of processed invoices and reviews them for audit as per agreed process and reports the results to check the accuracy of the employee's work and identify technical training needs to implement relevant training sessions
  • Set meetings with supervisors following audit to agree on the invoices to be reprocessed and suggest areas of improvement and set development plans if required
  • Revise the deductions of the POs conducted by the claims processors to conduct any reprocessing as needed and to ensure that the claims processors are aligned to operational procedures and deduction note template
  • Work on the potential fraudulent claims cases detected either by the processors or via audit reviews and reports the results to take the proper action regarding them
  • Receive the external audit sample requests sent by the payer via the account managers, retrieves and prepares all needed documents to be ready for discussion. Set meetings with the payers to check the requested samples and rationalizes the approved/deducted services for them
  • Participate in updating the operation procedures based on the policies of the newly added accounts to be aligned with the providers procedures in liaises with Network department and Approval department
  • Update the deduction notes template based on the accounts new requirement or the new polices and procedure to facilitate providing the reasons of the deductions when request
  • Review and discuss with providers the deductions based on the provider request to reach the reasons for resubmission upon request.
Job Requirements

  • BSc in Medicine or Pharmacy
  • Certified courses in health care management is preferred
  • 1 - 2 Years of Experience in Reimbursement unit
About this Company

Al Ahly Medical Services Totally owned by the National Bank of Egypt; one of the largest financial institutions in Africa & Middle East, Start-up issued capital of EGP 500 Million and paid-up capital of EGP 50 Million,we are Committed to provide both the public and private... (More)

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