Claims Coordinator - 02

Job Summary   

The Claims Coordinator is responsible for the timely processing of claims for all patients.

Major Duties and Responsibilities

• Accurately provide information to all incoming inquiries regarding claims, disputes, claim information, procedures, and regulations.

• Review claim requests and respond within established service level agreements

• Assists in managing departmental claim activities to ensure that payouts are adjudicated in an accurate and efficient manner

• Effectively ensure that detailed electronic records are maintained by accurately documenting all actions taken.

• Meeting measurable department standards as they relate to call quality, claim accuracy and efficiency measures as well as meeting teamwork, ownership, and professional development goals

• Reviews ER/OPD discrepancies and communicating with respected departments.

• Reviews the received claim forms if the ID copy attached is correct and form is complete.

• Reports the unadjusted and un-entered medical services to Manager of claims notification of excluded services for the newly contracted companies.

• Receives answered approvals from PSD, the Admission office and the Billing department.

• Takes ownership of customer claims by following requests through to completion and notifying appropriate personnel if problems exists.

• Display actions that align with our Vision, Mission, and Values

• Performs additional tasks and duties as assigned by superiors.

• English and Arabic speaking and typing.

• Computer literate (MS Office)

• Familiar with Medical Terminology

• Expert in Payers regulations