Key Responsibilities:
- Good communication skill.
- Knowledge in computers like MS office.
- Positive medical knowledge.
- Independently process Post hospitalization claims; process complex claims with minimal assistance
- Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information
- Suggest operational policies, workflows and process improvement initiatives
- Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same.
- Applying medical and surgical aspects to scrutinize the patient reports and other documents.
- Application of medical knowledge to bifurcate the claims.
- Analyzing and justifying the care and management given to the patient
- Thorough understanding of medical terminology in relation to diagnosis and procedures and meeting daily targets.
- Updating skills and medical knowledge with routine enhancement programs.
- Adjudication of claims as per the office memorandum of the concern scheme protocols
- Responsible for the accurate and timely processing of post discharge cashless claims.
- Meets quantity and quality claims processing standards.
- In-depth understanding of the hospitals processes, policies and procedures
- Verify Medical, billing related documents for further claim processing.