Claims Assessor/Officer
nextcare (arab gulf health services)
Total years of experience :18 years, 5 Months
• Manage routine daily claims evaluation and administration work.
• Coordinate work flow and meet deadlines.
• Review policies with regards to eligibility and cover limits.
• Internal Preauthorization.
• Attending calls and e-mails from insurance companies, clients and providers.
• Coordinating with international providers for direct billing.
• Data entry using ICD 9 and CPT codes.
• Increasing efficiency, minimizing errors and administration time.
• Handle call inquiries of all insurance companies, hospitals, and patient’s needs.
• Assist all doctors who are assigned for pre-evaluations of all cases.
• Follow up all status of claims, until a final judgment is made by medical claims officer.
• Manage and coordinate all pending cases of all providers about medical requirements needed case.
• Accurately enter data on the system for all outpatient cases.
• Responsible in updating all outpatient and denied cases in the system for future records.
• Entertain all inquiries from phone calls, faxes and email communication.
• Renders emergency measures to critically ill patients such as resuscitation and suctioning, cardiac massage, oxygen inhalation, assists in cut down procedures and gives emergency injections of drugs as epinephrine, lidocaine, etc.
• Takes vital signs, performs nursing assessment through clinical inspection, analyzes and utilizes findings as basis for planning nursing care activities.
• Administers medications and treatment exercising professional and legal responsibilities.
• Utilize interaction process with patients and family members creating therapeutic environment to alleviate anxiety and fear.
• Joins medical and nursing rounds to discuss patient’s condition and arrive at appropriate medical and nursing measures.
• Utilize terminal and concurrent disinfection and isolation techniques to prevent spread of infection.
• Act as a senior nurse in the afternoon or night shifts or when necessary.
• Prepares and endorse nursing care report and records to incoming staff to ensure continuity of care.
• Document everything that has been done to patients as well as observation from the time of admission to the time of discharge.
GPA is 85% and was a Dean's lister for 3 gradings