Billing Manager
Clemenceau Medical Center
مجموع سنوات الخبرة :12 years, 10 أشهر
Health Insurance Officer Sep.2009-till date
• Guiding the insured patients (outpatients/ inpatient) for the benefits of health insurance card as per the insurer and schedule of benefits for each product plan.
• Arrange pre approvals for all inpatient admissions (emergency & elective cases).
• To ensure that all admitted patients- with valid insurance policy through daily admission list are processed in the authorization office to avoid any denials and late notification.
• Ensures appropriate codes are applied by the facilities to diagnosis / treatment as specified in respective international classifications of diseases (ICD9 and/ or CPT4) & performs periodic Coding Audits for quality & completeness of coding & abstracting data and DRG calculations.
• Working knowledge of health care operations in the following: Billing, Insurance Verification & Claims processing.
• Research billing issues for accurate claims’ submission.
• Establish standards for the quality of work coming out of the medical authorization department, followed by a review of the medical notes by recommending improvements in procedures based on live examples experienced during the authorization process.
• To communicate with third party payers (insurance company) for any revisions or defaults.
• Notification of rejected services should be done using SEHA rejection notification form.
• Update staff about any new circulars from Abudhabi Health Authority.
• Seeking to achieve the maximum claim payment from the insurer (reduce any revenue loss from insurance.)
• Examine health insurance claims, within company guidelines to assure equitable treatment of policyholders and producers and to meet the company’s financial objectives
• To answer all related insurance queries from patients regarding costs of care being provided, in case of any exclusion by the insurance company as per policy and benefits.
• Complete understanding of insurance claim negotiation and settlement
Processes for group health insurance and employee benefits.
• Assissting with employee relations through employment practices.
• Analyzing specific applications for insurance & the premium, by setting the specific policy terms and conditions within company guidelines to be discussed with the insurer.
• Employees’ safety and health reporting.
• Responsible for risk management including investigation and resolution of incidents and identification of strategies to minimize risks, improve the quality and safety of engineers/workers within the projects’ areas.
• Maintain notices, accident reporting and carry outhazard audits as required to Facilitate the effectiveness and efficiency of operations, helps ensure the reliability of internal and external reporting and assists compliance with laws and regulations.
• Assists in the development of project proposals, recommendations, implementation plans, performance measurement tools, and training materials related to the assigned projects.