Description

Job Description

3. 1. Review and Audit Medical Claims to ensure their accuracy.
   2. Resubmission of rejected claims 
   3. Ensure that the agreed price list and provider manual from insurance companies are    followed for billing the service to the respective payers.
   4. Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future 
   5. Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission. 
   6. Submit the claims with proper codes and format to insurance companies within the stipulated time. 
   7. Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title. 

         OSH ROLES & RESPONSIBILITIES:

          GENERAL

1. Comply with reasonable OSH instructions, policies and safe working procedures
   1.       Use of appropriate personal protective equipment and safety systems.
   2.       Be familiar with emergency and evacuation procedures
   3.       Not willfully or recklessly endanger anyone’s health and safety
   4.       Assist with the preparation of risk assessments
   5.       Report OSH Hazards, incidents, Near misses and issues
   6.       Reduce, Reuse, Recycling of waste as much as possible
   7.       Attend all OSH Trainings, awareness programs and mock drills.
   8.       Participates in the OSHMS audits, inspections, ensuring standards are maintained

Additional duties/responsibilities (related to ADHICS) assigned to this position in clear, concise language:

Health Information Literacy and Skills:

2. Adhere to information systems policies and procedures as required by Health Care Organization. Privacy, Confidentiality of Health Information: 
   1. Follow security and privacy policies and procedures to the use of networks, including intranet and Internet.
   2. Follow confidentiality and security measures to protect electronic health information.
   3. Maintain data integrity and validity within an information system.
   4. Report any possible breaches of confidentiality in accordance with organizational policies.
    Health Information/Data Technical Security:

3. Apply departmental and organizational data and information system security policie Basic Computer Literacy Skills:
   1. Use basic word processing, spreadsheet and desktop presentation applications as applicable to your work.
   2. Demonstrate proficiency in Windows operating environment.
   3. Demonstrate use of email, addressing, forwarding, attachments, netiquette.

             BCP ROLES & RESPONSIBILITIES:

3.26     Responsibilities of staff (including all contractors) are:

3.26.1     Achieving an adequate level of general awareness regarding business continuity Being aware of the contents of their service areas disaster recovery plan and any specific role or responsibilities allocated.

2. Participating actively in the business continuity programme when required
   2. Ensuring information governance standards continue to be applied to data and information during an incident

Responsibilities

DUTIES AND RESPONSIBILITIES:

• Review and Audit Medical Claims to ensure their accuracy.
• Resubmission of rejected claims.
• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
• Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
• Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
• Submit the claims with proper codes and format to insurance companies within the stipulated time.
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

OSH ROLES & RESPONSIBILITIES

GENERAL

• Comply with reasonable OSH instructions, policies and safe working procedures.
• Use of appropriate personal protective equipment and safety systems.
• Be familiar with emergency and evacuation procedures.
• Not willfully or recklessly endanger anyone’s health and safety.
• Assist with the preparation of risk assessments.
• Report OSH Hazards, incidents, Near misses and issues.
• Reduce, Reuse, Recycling of waste as much as possible.
• Attend all OSH Trainings, awareness programs and mock drills.
• Participates in the OSHMS audits, inspections, ensuring standards are maintained.

Additional duties/responsibilities (related to ADHICS) assigned to this position:

Health Information Literacy and Skills

• Adhere to information systems policies and procedures as required by Health Care Organization.

Privacy, Confidentiality of Health Information

• Follow security and privacy policies and procedures to the use of networks, including intranet and Internet.
• Follow confidentiality and security measures to protect electronic health information.
• Maintain data integrity and validity within an information system.
• Report any possible breaches of confidentiality in accordance with organizational policies.

Health Information/Data Technical Security

• Apply departmental and organizational data and information system security policies.

Basic Computer Literacy Skills

• Use basic word processing, spreadsheet and desktop presentation applications as applicable to your work.
• Demonstrate proficiency in Windows operating environment.
• Demonstrate use of email, addressing, forwarding, attachments, netiquette.

BCP ROLES & RESPONSIBILITIES

• Achieving an adequate level of general awareness regarding business continuity.
• Being aware of the contents of their service areas disaster recovery plan and any specific role or responsibilities allocated.
• Participating actively in the business continuity programme when required.
• Ensuring information governance standards continue to be applied to data and information during an incident.

Qualifications

• Qualification: Medical/paramedical (Nursing, Pharmacy, etc.) graduate from a recognized university.
• Experience: Experience in Insurance Claims management/adjudication (minimum 2 years).
• Preferred Skill: Experience in Medical Coding is preferable.
• Language: Excellent command of oral and written English.