Description

Job Description

Job Description

1. DUTIES AND RESPONSIBILITIES

1. Verify the items in the open bills according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, rate plan etc.  Ensure that the bills are finalized in compliance with the contractual terms and price agreement.
   1. Finalize all codified credit bills for batch/statement generation based on the submission cycle (e.g., weekly, monthly etc). In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc and confirm the bill.
   2. In the case of insurance claims, prepare the xml batch for the finalized claims and validate in the regulator’s portal. Correct errors if any. In the case of corporate and individual payers prepare statement of claims for the period.
   3. In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc. 
   4. Ensure that the claims are appropriately dispatched by receiving the acknowledgement slip or verifying the regulatory post office with facility license number.
   5. Can prepare required monthly reports upon request.               
   6. Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

Responsibilities

1. DUTIES AND RESPONSIBILITIES

1. Verify the items in the open bills according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, rate plan etc.  Ensure that the bills are finalized in compliance with the contractual terms and price agreement.
   1. Finalize all codified credit bills for batch/statement generation based on the submission cycle (e.g., weekly, monthly etc). In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc and confirm the bill.
   2. In the case of insurance claims, prepare the xml batch for the finalized claims and validate in the regulator’s portal. Correct errors if any. In the case of corporate and individual payers prepare statement of claims for the period.
   3. In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc. 
   4. Ensure that the claims are appropriately dispatched by receiving the acknowledgement slip or verifying the regulatory post office with facility license number.
   5. Can prepare required monthly reports upon request.               
   6. Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

Qualifications

4. QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS
   1. Bachelor of Commerce, Business Administration or any other degree. Paramedical or coding knowledge will be advantage.
   2. Two years minimum of experience.
   3. Knowledge of insurance billing procedure.
   4. Knowledge in using computer and related software applications.
   5. MS Office Experience, Word, Excel and Power point.
   6. Extreme organization skills.
   7. Communication, interpersonal skills as applied to interaction with co-workers, supervisor and customers.