Insurance Coordinator / Claims Processor / Cashier
Al Ain Fertility Center
Total years of experience :8 years, 7 Months
➢ Getting approvals for medical procedures.
➢ Ensuring coverage of claims, guiding staff for correct use age of claim forms, approval papers.
➢ Coordinating with insurance companies for obtaining information on new policies and their coverage.
➢ Answered inquiries from providers on the subject of claim, eligibility, covered benefits and approval status issue.
➢ Explaining coverage of medical benefits to patients when required.
➢ To liaise with patients regarding their eligibility and entitlements.
➢ To coordinate and co-operate with colleagues of the same department and other related departments for smooth running of Insurance operations.
➢ Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements.
➢ Entered claims data into system.
➢ Assisting invoicing department in insurance processing and billing.
➢ Preparing quotations and invoices for cash patients.
➢ Depositing the collected amount in bank.
➢ Manages and processes insurance claims.
➢ Checking and differentiating the non-covered diagnosis or investigations.
➢ Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements.
➢ Entered claims data into system.
➢ Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims.
➢ Followed adjudication policies and procedures to make sure proper payment of claims.
➢ Knowledge of ICD-9 and CPT codes which are diagnostic coding programs.
➢ Encoding the appropriate ICD and CPT codes.
➢ Checking claims information for accuracy, reference number, insurance card, member ID and drug-injection procedure.
➢ Maintains updated laboratory, radiology, clinic procedure, and drug codes as needed to be able to accurate code claims.
➢ Efficiently coordinate with I.T. department on any changes or updates on the codes to be uploaded to the Hospital Information System.
➢ Maintains confidentiality regarding patients/staff information and administrative matter of confidential nature.
➢ Receive customers and visitors with welcome and courtesy.
➢ Fix appointments for patients; keep accurate record; ensure concerned people are informed in advance and necessary arrangements have been made.
➢ Coordinate with departmental staff for the smooth running of the daily operations on a timely manner.
➢ Maintain professional confidentiality at all times.
➢ Performs basic nursing duties within the scope of practice such as collecting and delivering services to the ward.
➢ Perform bed making.
➢ Takes and record vital signs.
➢ Orientates patient on arrival.
➢ Assist and instruct visitors on visiting hour's policy.
➢ Assist patient with personal hygiene.
➢ Ensures patient safety and report if any incident or unsafe practice to the Charge Nurse/ Senior staff.
➢ Ensure that the work environment is clean, organize and safe for patient and co-workers.
➢ Ensure patients confidentiality.
Associate in Health Science Education (AHSE) -Nursing Liceo de Cagayan University Cagayan de Oro City, Philippines March 2006
