Network Coordinator
NAS Administration Services LLC
Total years of experience :11 years, 8 Months
Report to the Network Manager
Prepare HAAD and DHA contract for the new provider, with copy of the prices both contract copies (NAS & Provider), along with the manual and the agreed discount.
Enter new provider in the system including all the informations specially their type of networks and bank account details.
Adding of new clinicians/doctors in the system (specially their Specialization and Category, DHA/HAAD License numbers with issue date/expiration date)
To be accessible and responsive to providers, NAS Staff queries and concerns.
Coordinate, respond to all payers queries and requests related to providers available in area.
To deal proactively with insured’s complaints regarding providers and inform the responsible manager accordingly.
To act as a communication point between providers and claims team.
To carry out any other reasonable duties as requested by the direct manager or the Medical Director.
Auditing, monitoring and completing the filing documents.
Maintains and arranges insurance files and data (filing system(Contracts, Network Agreement, Licenses, Price List, Emails Conversations, Empanelment, Financial Data and List of Branches).
Keep updating the network directories.
Keep updating the provider email address and information.
Maintain filing, Scanning and uploading Accounts Reconciliation and Signoff in the system.
Receive the claims and invoices from the providers and payers.
Update the claims submission log with the submission details and delivery and courier information.
Create a batch on the system for each batch of invoices received per provider or per payer.
Enter the details per each invoice in the system.
Validate the batch in respect to the total amount claimed and total amount submitted.
Upload EDI files to the system.
Coordinate with the providers or payers in case of mismatch between the provided statement of account and actual invoice submission.
Prepare letters for the providers informing them of those beneficiaries not included under NAS or if the claims are falling under the cut-off period.
Coordinate and communicate with all the providers who did not submit their monthly billing on time in order to avoid late submissions and to ensure that all received claims are reported for technical data purposes.
Request soft copy and EDI Statement from the providers
Separation of Claims (Hospital/Pharmacy and Polyclinic)
Analyzing of Claims (Out-Patient/In-Patient/Dental/Maternity and Optical)
Preparing EDI and Automated through Microsoft Excel using V-look Up, Pivot, Sorting, Exact, IF, Concatenate and Trim Formula.
Upload Claims in the System.
Download Remarks from the system.
Checking and completing unfound details in the system.
Secure and provide beneficiary names.
Barcode Claims
Decision Making in proceeding or rejecting claims in the Invoice Suspicious Duplication from the IJET
Decision making in assigning/proceeding or rejecting claims in Authorization Missing from the IJET.
-Prepares cash disbursement Voucher and Checks like payments to other institutions or expenses
-Prepares General Journal Transactions (including all non-cash transactions like supplies inventory every month)
-Prepares remittances of Contribution/Loan to Regulatory Agencies (BIR, Pag-Ibig, ST SAND Philhealth)
-Maintains updated supplies inventory and purchased office supplies and equipment as authorization by management
-Maintains an orderly accounting filing system
-Maintains updated Books Of Accounts (General Ledger, General Journal, Cash Disbursement Journal and Cash Receipts Journal)
-Make Entries for various collections like payments of Institutions, Provincial Offices, Partners and Clients
-Encode/Record and Posting all transactions to Peach tree Accounting System (cash vouchers, general voucher, receipts and deposit slips)
-Conduct Monthly reconciliation of every bank account (BDO, Land Bank, CARD SHE, CARD Bank and BPI)
-Generate reports from Peach tree Accounting System (Financial Statement and Balance Sheet)
-Sales and Marketing/Offers products to clients/customers while maintaining company's integrity and interest.
-Work in different roles including documentation, investigation, and analysis in ha dli ng claims of the insurer.
-Validate clients/members if (members died) analysing and investigating the cause of death.
-Review claims documents submitted by 45 Provincial Offices if documents are payable.
-Ensure completeness of claims documents.
-Submit claims documents to partner (Pioneer Life Inc.)
-Monitors payment from partner (Pioneer Life Inc.)
-Prepares claims monthly report (Microsoft Excel)
Bachelor's of Science and Business Accountancy