Network Coordinator
NAS Administration Services LLC
Total years of experience :18 years, 3 Months
Reports to the Network Manager and with matrix to the Medical Director.
Obtain all the necessary documents to validate the provider in the system. (Trade License, HAAD/DHA/MOH License, and power of attorney if the payment should be issued other than the name of the provider.
Prepare HAAD contract for the new provider in Abu Dhabi, with copy of the prices both contract copies (NAS & Provider), along with the manual and the agreed discount.
Ensure that new small providers who signed up receive comprehensive training on NAS procedures, JET, EDI submission, billing and other process by physical attendance or over the phone.
Prepare the providers database (Prices, Name of Doctors, Licenses, Discounts, contact data, etc. and ensured that it is uploaded in the system.
Ensure that the database of the existing contracted providers is maintained properly in the system.
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.
Handling International Claims (outside UAE)
Manually encode the details of the patient, FOB, Invoice number and amount.
Prepare corresponding letters to the provider.
Making sure that the amount in the system tally’s on the Statement of Account submitted by the provider.
Coordinate with the insurance coordinators if there is any discrepancy in amount.
Separates In Patients claims to the regular claims.
Filing other documents and arranged the claims according to the reception date.
Performed other task assigned by my immediate supervisor.
Received bills daily from Medical Claims receiving clerk. Files receiving summary per hospital/dentist.
Encodes information to the Central Processing System (CPS). Verifies benefits and limitation thru Medicard intranet solutions. Determines the amount to be paid and balances the transaction form hospital billing.
Make sure that all hospital bills must have LOA or approval number in order to validate approved and disapproved charges.
Make sure that all patients availed dental procedure must have a dental coverage.
Make sure that all advances/cost plus must be billed by Medicard billing clerk.
Submit daily processed report and weekly status report to the claims Junior Supervisor.
Maintains file for daily processed report, receiving summary, action memos, incident report, logbook and other pertinent documents.
Make sure that all bills must be processed within 5 days period and be paid on or before the due dates.
Organize the entire day-to-day office work, which includes correspondence, organizing the calendar and systematic filing of records.
Issuance of receipt to costumer encodes pawn ticket and reconcile with the petty cash.
Manage the customer accounts, analysis of costumer dues and constant review of payment terms.
Attend to customer inquiries as well as complaints.
Other clerical task that may assigned from time to time.