CLAIMS ANALYST
GlobeMed Qatar LLC
Total years of experience :8 years, 10 Months
SEHA TPA of NHIC Health Scheme project.
Reason for Leaving: Preterm termination of the project
Responsible in performing technical and medical audit on uploaded claims and ensure an appropriate application of policy and tariff agreements.
System processes includes claim reception, medical assessment, pricing and audit, and closing.
Coding Stanadard: ICD-10-AM/ACHI/ACS
Systems Softwares: I-geme, I-care, Cognos, PICQ
Evaluate claim documentation for quality, completeness and code consistency, reviewing the information and deciding if the claim is eligible for payment in accordance with the organization's policies and procedures (Direct, OP/IP consultation, pharmacy, physiotherapy, and laboratory services and reimbursement).
Process claim forms, adjudicates for provision of deductibles, co-pays, co-insurance and provider settlements
Ensure compliance with all coding mandates and regulations.
Entry and processing (edit/entry) medical direct and reimbursement claims through in-house data software, done with soft documents. Ensuring the data are properly and accurately entered and adjudicated.
Task to monitor, document, and implement standards as adhered to mandatory government regulation and international policy (QMS 2001: SA 8000), includes custody of documents and Document Control.
Assist in the developing and updating of company policy and procedure)
Facilitates, organizes, and coordinates training and awareness.
Perform basic clerical skills
Employee relations and service.
Serve as officer-in-charge of Occupational Safety and Health
Carry out basic secretarial duty to the office of the Plantation Manager.
Undergraduate
courses: Medical Transcription –Short course
