Description

Job Description

The post holder provide support to the department in obtaining pre-authorization from insurance companies and verification of insurance coverage for the patients by reviewing, interpreting and abstracting clinical information from patient’s record for the purpose of reimbursement, research and compliance with regulatory requirements utilizing established coding principles and protocols. In addition, this role recommends and executes policies and procedure to ensure timely and accurate resolution of all insurance issues.

Billing/ Insurance

• Advises financial information to patients as needed to keep them duly informed of treatment costs.
• Responds as appropriate to enquiries from patients and third-party payers regarding treatment, benefits and billings, coordinating to support the resolution of related problems.
• Acquires and verifies insurance and/or third-party authorisation for financial cover (insurance) of patients at the time of making appointments.
• Performs billing and verification of charges in an accurate manner and undertakes preparation of daily summary of all transactions as well as cash flow, ensuring proper handover to Finance on a daily basis.
• Coordinates with insurance companies for patient’s insurance card validity and coverage of benefits.
• Obtains pre-authorization from insurance companies for coverage for patients’ treatment
• Provides written and verbal responses to leadership on questions and concerns regarding their insurance explanation of benefits.
• Continuously reviews applicable regulations, updates and maintains current knowledge of health insurance related information.
• Prepares and review routine billing reports to ensure timely and accurate billing activity.

Coding

• Accurately follows coding guidelines and legal requirements to ensure compliance with DHA / DHCC or other applicable regulatory bodies.

Calls

• Answers telephone enquires promptly, efficient and politely to support the patient query on all insurance related matters.

Patient Experience

• Undertakes daily administrative duties as required within the Clinic to ensure the efficiency of patient flow.

Requirements:

• Minimum secondary level education
• Diploma or Bachelor’s Degree
• At least 2 years’ experience in Billing or Insurance within a clinic/OPD environment on Reception, Call Centre, Patient Support services.
• Experience with CPQ and Compliance framework.
• Working knowledge of CPT, CDT, HCPCS, ICD-9 or 10 and DRGs.
• Working Knowledge in IT & Call Centre related Software Systems.