Medical Claims Auditor
Jordan Engineers Association
مجموع سنوات الخبرة :16 years, 5 أشهر
• Studying, analyzing and auditing all forms of financial medical claims sent by healthcare providers and matching them with different types of insurance policies and healthcare providers contracts
• Auditing the processes of entering and analyzing the financial claims to healthcare providers (outside and inside the hospital) as assigned
• Participate in proposing objectives, mechanisms and procedures for resolving claims, entering and auditing them, and preparing, auditing and approving the outputs of the computer programs related to medical claims executed by the IT Department.
• Contribute to the study and control of contracts inside and outside the hospital as assigned
• Follow up on new medical procedures and prices.
• Follow up the objection of the healthcare providers to the payments.
• Coordination with the medical approvals department regarding medical coverage
• Responding to the medical network’s inquiries and responding to insured members’ inquiries related to cases referred by the department head
Using blended learning method (Face to face and virtual/online lectures) to teach many courses related to health administration, public health and health informatics. Examples; (Introduction to Health Informatics, Health Policy, Introduction to Management principles, Introduction to Health Management, Organizational Behavior, Biology and anatomy, drugs and society, sociology of health, illness and healthcare, Epidemiology, ethics in healthcare, Electronic health record, medical coding and billing, Health behavior, Global health, Health communication and many other courses)
Experience in using Blackboard and Blackboard ultra-system to conduct online courses. Using SwiftAssess system to add questions and conduct online exams for students.
Being a branch coordinator, responsible for performing all the administrative work for the college at the branch.
Working as member of the examination committee at the branch Working as course coordinator for many teaching subjects.
Working as member in the college and university Quality and Accreditation team.
Working as students consultant and director at the students affairs department at the branch
Responsible for supervising micro-insurance products and analysis of medical claims related to hospitalization services for the clients,
• Liaising with branches and insurance companies.
• Trainings programs for employees.
• Preparing monthly financial reconciliation report, monitoring KPIs related to the products and preparing different reports related to work
• Responsible for all types of medical claims analysis, settlement and solving problems in addition to other( in &out)-patient medical claims analysis(cash or open)&designated health care providers and processing on daily bases,
• Providing in & out patient approvals and preparing pre-approval forms for in-patient admissions & out-patient cases and issuing checks for designated providers.
• Liaison with group medical department teams and solving insurance problems faced from their clients.
• Receiving calls from different health care providers to give them the proper approvals.
• Responsible for The American Embassy in Amman insurance contract (medical insurance customer service representative at the US Embassy in Amman).
• Responsible for the American embassy in Yemen health insurance contract for the employees. Receiving prepaid claims from them, analyze them and provide them the proper payments. Providing approvals for hospitalization cases
Responsible for medical claims evaluation, invoices assessment, processing all the received invoices on daily bases and reporting to the senior supervisor.
Responsible for dispensing medicines for clients, providing the proper medical and pharmaceutical advice, preparing medical mixtures to clients and ordering medicines from the store