Insurance and claims manager
Mezyad medical center
مجموع سنوات الخبرة :13 years, 9 أشهر
Administered everyday operations and processed all claims.
Monitored working of staff and ensured compliance to quality.
Managed work of all subcontractors according to required quality standards.
Provided required training to all data entry personnel according to management policies and procedures.
Participated in all employee performance reviews and assisted hiring appropriate candidates.
Assisted all staff members to resolve all issues for internal and external customers.
Review, share in developing of HIS and ensure the accuracy of implementation of the updates.
Follow and review of all OUP & IP approvals.
Ensure proper payment of claims and update finance by any rejections or delayed
Ensure timely recovery of rejected or delayed claims amount as per insurance terms and policies.
Providing advice on making a claim and the processes involved.
Collecting accurate information and documents to proceed with a claim.
Train, develop and manage a team of handlers who are newer to the insurance industry, by developing and executing on individual professional development plans for each team member
Handling all negotiations and communications with insurance companies and update contract and process.
Keep Finance advised of any material claims as set out in claims authority and claims protocols and procedures and work with them to effect recoveries.
Make recommendations regarding the accuracy of documentation and process improvements to avoid fraud.
Discusses and reviews any issues uncovered through the calming process, finalizes audit work papers and drafts a final report of recommendations and observations for distribution to management and physicians.
Follow at all times HAAD rules for claiming system and insurance Claims Standards.
Develop an understanding of marketing and underwriting strategies for my business area and
Conducts monthly self-audits against Best Practices standards.
Give efficient assistance to monument in planning and forecasting for continuous process improvement within the insurance process.
Train concerning staff and departments to be familiar with insurance policy coverage, terms, conditions, exclusions.
Analysis the reasons of rejections, submit periodic report and action plane to decrease rate of rejections.
Reviewing & creating monthly, quarterly and yearly revenue and update the marketing plane improve the income.
Supervised all claim examiners to process claims for one product lines.
Prepared various reports for claim adjudication for various examiners.
Provided required actions for various processes.
Monitored all disability claims and ensured compliance to all audit requirements.
Reviewed claim files and ensure appropriate coding for all claims.
Collection of payment and reconciliation with Insurance Companies & TPAs for retrieving outstanding payment.
Analyzes data to identify trends and problems.
Follow at all times HAAD rules for claiming system and insurance Claims Standards.
Handling all negotiations and communications with insurance companies and update contract and process.
Ensure timely recovery of rejected or delayed claims amount as per insurance terms and policies.
Train concerning staff and departments to be familiar with insurance policy coverage, terms, conditions, exclusions.
Make recommendations regarding the accuracy of documentation and process improvements to avoid fraud.
Discusses and reviews any issues uncovered through the calming process, finalizes audit work papers and drafts a final report of recommendations and observations for distribution to management and physicians.
Supervises coding staff and trains employees to ensure that the hospital receives appropriate reimbursement and conforms to applicable guidelines and regulations.
Ensures the accuracy and timeliness of the coding process.
Internal Audit of IP & OUP claims before submission as per the updated insurance policies and requirements.
Review, share in developing and follow the updates of HIS.
Ensure high level of technical claim file quality from team members.
professional development plans for each team member
Keep Finance advised of any material claims as set out in claims authority and claims protocols and procedures and work with them to affect recoveries.
Preparing audit tools for checking and evaluate claims.
Education session for Physicians & Nurses regarding the updated insurance policy coverage, terms, conditions, exclusions guidelines.
Two weekly departments meeting with the staff to discuss the updates and monitoring the implementation of our future plan to decrease the rejections and increase the facility income.
Preparing KPIs for all processes and related departments.
Submit of monthly & Quarter reports to management regarding the revenue and the imagination of department to increase the income base on the market circumstances and insurance updates.
Make recommendations regarding the accuracy of documentation and process improvements to avoid fraud.
Discusses and reviews any issues uncovered through the calming process, finalizes audit work papers and drafts a final report of recommendations and observations for distribution to management and physicians.
Analyzes data to identify trends and problems.
study the claiming process. The program also includes updated content on both ICD-9 and ICD-10 coding. complete real-world examples of coding, and learn how to manage records and file claims, prepare insurance forms, and handle billing for clinics, doctors’ offices, or private billing services.