Medical Billing-Audit Supervisor
AlMoosa specialist Hospital
Total years of experience :22 years, 4 Months
A self-motivated professional with strong analytical and communication skills. Having an understanding of the value of time cost and quality of work. Seeking a challenging and responsible position in Medical Insurance Field with progressive organization that gives scope to apply my knowledge and skills.
Professional Highlights
Medical Billing and Coding
Strong organizational and analytical skills
Administrative Support
Ability to Maintain Confidentially
Minute Taking
Excellent Computer Skills
Report Writing
Ability to multitask and manage demands
Productivity & Goals
Ability to work under pressure
Claims Processing and Auditing with CPT ICD 9 ICD 10
Implementation of claims processing procedure.
Medical knowledge
Commitment & Cooperation
Experience
Medical Claims Auditing Supervisor December 2017 to Current
Medical Coding and Billing Al-Hassa-Hafuf. Saudi Arabia
Al Moosa Specialist Hospital
Job Description:
In-Patient billing for accuracy in accordance to financial mythologies and perform auditing for cost effectiveness.
Monitor In-Patient Discharges to assure that bills had been generated.
Finalize all invoices to be delivered to finance in a timely manner within the billing month of admission/discharge.
Finalize cash invoice on real time billing and finalize audited bills before patient discharge.
Participant in performance improvement.
Responsible to meet department productivity and quality goals.
Cooperate with other Supervisors and Managers.
Responsibilities:
Implement options to meet the individual health needs through communications and available resources to provide the right health care, on the right time, in the right setting by accurate billing.
Use available codes resources billing purposes upon utilization of services for cost effective patient care.
Follow up In-Patient Billing and auditing Ensuring Accuracy in a timely manner.
Follow up In-Patient Admissions and Discharges bills on daily basis and provide the right billing to the suggested charged services and fasten the TAT for billing.
Participant in performance improvement activities QI/PI and establish measurement indicators.
Assist the front desk section where there are causes of delay which is affecting the discharge process and customers invoices.
Close communication with approval Center and ADT for effective billing and claim attachment.
Ensures confidentiality of all patient record and derived data.
• Provide guidance and direction with regard to coverage analysis, liability investigation and determination, bodily injury evaluation, negotiation and settlement.
• Audit claim handling processes. Recommend and coordinate needed changes based on process analysis.
• Effectively handle and resolve consumer complaints and be able to effectively address adjusters who are the source of the complaint.
• Develop, analyze, and prepare reports to submit to management on team performance.
• Supervise staff in accordance with company policies and procedures.
• Conduct interviews, hire new staff, and provide employee orientation.
• Coach and provide career development advice to staff.
• Track employee goals and conduct employee performance reviews.
• Responsible for staff scheduling to include: employee vacations, employee breaks, and back-up for absent employees.
• Schedule and conduct staff meetings.
• Responsible to meet department productivity and quality goals.
• Communicate with other Supervisors and Managers.
• Work with other departments to establish and maintain collaborative relationships toward achieving department and company goals.
• Other duties as assigned.
Current: • Working as Medical claims Review Officer for Medical Claims Reviewing Department since January 2012 at
Saudi Arabian Cooperative Insurance Company Riyadh (SAICO) till to date.
• Responsibilities Included: • Acting Supervising a team of 8 for reviewing direct medical claims and team 4 for reviewing cash(Re-Imbursment) claims.
Current: • Working as Senior Medical Claims Review Officer for Medical Claims Reviewing Department since January 2012 at
Saudi Arabian Cooperative Insurance Company Riyadh (SAICO) till to date.
• Ensure productivity of claims officer is appropriate and acceptable as to their level of service,
experience & assigned business group or medical provider.
• Ensure the implementation of 'Usual and customary rates' with Medical Providers.
• Participate in maintaining good relationships with our clients and brokers.
• Liaise with external stakeholders (brokers, group secretaries etc) and other departments
(Helpline) regarding escalated issues.
• Coach team members to technically assess claims, thereby contributing towards the attainment of targeted decline ratios.
• To work closely with the Company Head of Medical Division.
• To be able to carry out a change management process.
• Support the day to day organization of the department through strong Man Management skills with a focus on cost containment being a key factor.
• Ensure a program of quality is implemented within Department
• In the absence of the Claims Manager, furnish the Head of Operations/General Manager with weekly claims Reports for communication to the Head of Medical Division.
• Carry out individual performance management in order to: o Carry out regular team meetings to improve internal communication and to support the claims
manager by informing staff of departmental policies and protocols. Idea generation and problem
solving should be part of such meetings.
o Identify and implement system & process enhancement ideas to maximize productivity and improve the quality of adjudication decisions.
o To supervise and ensure the effective management of their assigned claims team to ensure
company objectives are achieved.
o Verify and release processed claims with payment amounts in excess of Team Leaders to ensure the accurate settlement of high value claims.
• Responsibilities included
• Studying claims from benefit providers received via online and by fax
• Adjudicating and replying to benefit providers in time
• As a team member in the department handling controversial claims
• As a reference for handling medical claims to rest of the team
• In the absence of the Approvals Manager, furnish the tasks at hand, and liaise with clients for their
pending approvals.
Responsibilties:
• Adjudicate and process Claims within the agreed company SLA, clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target.
• Ensure correct adjudication of claims thus allowing accurate reporting on claims data.
• Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention
• Contribute to the team and departmental productivity targets so that the agreed SLA is achieved and a high level of customer service is provided.
• In line with the company’s policy on cost containment identify duplicate payments, possible non-disclosure and fraudulent claims.
• Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction.
• Expand medical knowledge through claims processing.
• Aware twice by company for Putting up excellent work.
• Verifying the gross total entered in data entry department.
• Verifying eligibility.
• Maintaining & looking into history of past benefits.
• Identifying duplicate charges
• Checking approvals & second opinion
• Calculating payable benefits
• Issuance of credit note and debit note.
• Processing the claims as per the agreed price list, discounts & as per the policy deductible or co-insurance.
• Processed medical and dental claims, referrals, encounters, eye and prescription claims.
• Maintained heavy telephone contact with customers
working As Charge Nurse in Primary Health Care Centres of Royal Commission for Jubail and Yanbu---Jubail.
• Performs basic nursing care (e.g. assessment through monitoring and record vital signs
• Ensure proper documentation and referral of patient condition.
• Carrier out doctors orders promptly and efficiently
• Maintain professional and good interpersonal relation ship with co-workers.
• Update knowledge about medical and nursing professions by attending Symposiums Lectures and seminars
Working as a Staff Nurse in Medical, Surgical and Emergency Departments
• Responsible in the management of area of assignment ensure smooth working relationship
• Maintain open communication with senior staff. Update staff concern Developments and existing problems
• Maintain good interpersonal and professional relationship with other members of medical team.