Description

Job Description

MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Team Leader – Reconciliation who will be responsible for overseeing the reconciliation of accounts with healthcare providers and primary insurance companies, with the resubmission of rejected or denied claims to ensure timely resolution and optimal financial outcomes.

Your Job:

• Supervise and lead the reconciliation team, ensuring high performance and adherence to timelines.
• Monitor team workloads, assign tasks effectively, and address performance gaps.
• Oversee the reconciliation of providers/Primary insurance companies, including reviewing claims, invoices, and payment records.
• Ensure accurate and timely resolution of account discrepancies and disputes with providers/Primary insurance companies.
• Manage the resubmission process for denied or rejected claims to maximize recovery rates.
• Investigate the root causes of claim denials and implement corrective actions to reduce recurrence.
• Analyze trends in claims denials and reconciliation discrepancies to identify systemic issues.
• Develop and implement strategies to improve first-pass resolution rates and reconciliation accuracy.
• Streamline workflows and introduce best practices for both reconciliation and resubmission processes.
• Foster strong relationships with providers/Primary insurance companies to address concerns effectively and maintain trust.
• Work closely with internal departments such as claims, finance, and provider networks to resolve issues. Ensure alignment with organizational objectives and compliance requirements.
• Prepare and present reports on reconciliation performance metrics to management.
• Ensure compliance with internal policies, payer guidelines, and healthcare regulations.

Your Profile:

• Bachelor’s degree in Medicine/ Pharmacy.
• Minimum 5 years’ experience in health insurance
• Proven experience in reconciliation, claims management, or resubmission processes.
• Strong leadership, analytical, and problem-solving skills.
• Excellent communication and interpersonal abilities to manage internal and external relationships.
• Proficiency in reconciliation and claims management software, as well as MS Office Suite.
• Detail-oriented with strong organizational and multitasking capabilities.

Benefits found in job post

Medical insurance