Claims Manager
Katameya, Cairo
Claims Manager
Katameya, Cairoposted 1 day ago33Applicants for1 open position
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Job Description
- Review and monitor the average cost per claim across the Hospital and income breakdown and ensure that they align with the SGH studies and agreed pricing.
- Support the development of the Hospital's e-claim system and ensure updating hospital information to ensure the SHIB integration project's success.
- Monitor all the claim management activities, within the Hospital, ensure that unprocessed and denied claims were reviewed and finalized, and comply with the agreed framework to ensure revenue optimization.
- Ensure that RCM Specialist executes claims collection as per agreed terms and timing with the insurance companies.
- Monitor and review all the reports related to AR ( Total Sum, Days outstanding, AR per company), bad debts expense, etc. Ensure that prompt actions are taken to resolve collection issues to ensure cash-flows streams for the Hospital and SGH.
- Ensure that proper customer service related to billing and collection is delivered for all the patients.
- Ensure that all billing information is entered accurately to the system and comply with CCHI justification rules on the claim processing
- Monitor rejection rates, identify common issues and work on developing appropriate plans to decrease rejection rates.
- Manage central account activities' execution to ensure that all billing, payments, contracts, accruals, and related transactions are treated appropriately according to internal and statutory controls and the agreed terms with third-party.
- Ensure that the claims team follows regulations and standards operating procedures.
Job Requirements
- Medical Educational background is a must ( Physicians only )
- Not less than 4 years experience in a managerial position
- KSA Market Experience is A Mandatory
- Strong Experience in Managing claims , Auditing , and dealing with Insurance Companies
- Strong knowledge of medical insurance policies, claims cycle, and reimbursement procedures.
- Proficiency in hospital information systems (HIS), ERP, and claims management software.
- Advanced knowledge of medical coding (ICD, CPT, HCPCS) and healthcare billing standards.
- Strong analytical skills with the ability to detect fraudulent or incorrect claims
