Insurance Executive

Overview

• Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits
• + Respond to Insurance/ TPA queries and liaise with concerned department without any delay.
• + Responsible for receiving, evaluating and escalating second opinion cases and case management
• + Perform night shift duty and on public holidays as per duty roster.
• + Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
• + Handle Auditing Process.
• Arrange required documents and papers and check with coders in order to assist the external Auditors
• + Attend Meetings and Presentation
• + Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
• + Prepare cost estimate for procedures for Cash Patient
• + To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
• + Managing and handling pending cases (if any) to the next shift colleagues.
• The incumbent checks and sequences the most accurate ICD-9/ ICD10- CM/CPT/HCPCS/DRG/Other codes for diagnoses and procedures for documented information.
• Assures the final diagnoses and operative procedures as stated by the physician are valid and complete.
• Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
• Evaluates the record for documentation consistency and adequacy.
• Ensures that the final diagnosis accurately reflects the care and treatment rendered.
• Computes and gives the correct DRG coding all inpatients cases.
• Providing training and guiding other coders / Medical Records Technicians in coding, updating them with new coding rules and regulations as and when it is necessary.
• Analyzes doctors’ documentation to assure the appropriate Evaluation &
• Ensures coding is as per HAAD guidelines and regulations.
• Provides feedback to Doctors regarding coding errors or oversights.
• Constantly updates to the latest coding versions and HAAD coding directives.
• Management (E & M) levels are assigned using the correct CPT code.
• Experience in Insurance Claims management/adjudication (minimum 2 years).
• Experience in Medical Coding ICD, CPT, DRG and HCPCS.
• Flexible and able to work under pressure
• Knowledge in using computer and related software applications and proficient in using MS office programs.
• Communication, interpersonal skills as applied to interaction with co-workers, supervisor and customers and capability to interact with all levels in the organization.
• Must display a neat, clean professional appearance.
• Excellent command of oral and written English. Arabic language advantageous/desirable but not essential.
• Must communicate in a timely manner and exhibit good listening skills.