Job Description

Roles and Responsibilities

• Reviewing patient bills for accuracy and completeness, and obtaining any missing information
• Evaluates and processes claims per insurance policy terms and conditions
•  Work per company policies and procedures
• Identify and report back any type of claims observation or issues that may affect the process
• Evaluates and ensures that all claims denied or underpaid inappropriately by Payers are identified, appealed and reversed
• Reviewing claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries and makes recommendations for resolution
• Ensures that targets are met for department Turnaround time, Quality and Productivity

Education, Experience, and skills needed

• Education: Degree in any related field preferably life science background.
• Over 2 years’ experience in Revenue Cycle Management – Eligibility and Authorization, Claim Submission & Resubmission. Both inpatient and outpatient experience preferred.
• Expert knowledge of medical conditions, treatments, procedures and standard codes
• Willingness to work in different shifts
• Willingness to work from a different facility
• Analytical skills to review the account before submission to payer and ensure all required data elements are correct as per the insurance and medical code sets
• Basic understanding of the billing and payer adjudication guidelines related to DHA
• Basic knowledge of medical terminology
• Proficiency in the use of PCs and MS Office suite
• Excellent in communication skills
• Understanding of the various RCM departments
• Fluent Arabic speaking skills