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Job Description
- Perform analysis for denials and unpaid claims making appropriate corrections until worked to resolution to include phone call, claims resubmission, appeal, or reconsideration.
- Demonstrate a working knowledge of basic healthcare contractual obligations such as claim filing limits, medical necessity, and dual coverage through Quality Assurance (QA) accuracy and data.
- Ensure expeditious and accurate insurance reimbursement for all Government and Managed Care payors.
- Monitors and audits status of rejections assigned to other areas related pricing, profiling and coding teams
- Audits member liability denials to assure quality of claim determinations and ensures compliance with department plan organization requirements.
- Obtain, manage, and analyze Audit Tracking Report to identify missing records that have not been captured within the system.
Job Requirements
- Medical Educational background is a MUST
- Excellent user of Analysis tools ( Excel , power BI , Python ,..)
- Excellent Communication and Analytical skills
- Healthcare insurance background is highly Preferred
- Saudi Market Background will be an Asset