Sr.Claims Coordinator

Major Duties and Responsibilities

 Ensures through his/her actions, either directly or indirectly, that a superior quality of medical treatment, compassion and understanding is given to every patient served at the NMC Hospitals and Clinics.
 Approves and re-checks all monthly corporate claims submitted by the various claims Coordinator & clerks.
 Reports the unadjusted and un-entered medical services to Manager of claims notification of excluded services for the newly contracted companies.
 Coordinates with the Accounting section by providing them monthly reports of amounts payable by contracted companies.
 Consolidates all claim rejections and deductions.
 Takes part in drafting contracts with the new insurance companies.
 Suggests new computer functions to improve the section performance.
 Prepare refund of payment for services & investigation as per the instruction of the Claims Manager.
 Check on daily basis the in-patient billing if any adjustment would be required.
 Check if there are any services or medication without service code for charging purpose.
 Performs additional tasks and duties as assigned by Superiors.

Reporting to
 Claims Manager

Job Summary

Receiving and sending Approvals to all Insurance and Direct Companies to those patients for admission and for special services ordered by the physicians in the hospital ward.  Receiving answered approvals from the Insurance or Direct Companies.

Major Duties and Responsibilities

·         Ensures through his/ her actions, either directly or indirectly, that a superior quality of medical treatment, compassion and understanding is given to every patient served at the NMC Hospitals and Clinics.

·         Receiving claim form from the nurses or relatives of the patient who will be admitted for approval purposes.

·         Checking the claim form received if the ID copy attached is correct.

·         Browsing of the UCAF form in the system to check if the encoder entered the requested investigation of the physicians noting that the patient is for admission.

·         Preparing the printed UCAF and mail through fax or email to the concerned Insurance Company or Direct Company.

·         Calling the Company for follow-up for approval.

·         Receiving answered approvals/ disapprovals through fax or email.  And conveying the same to the patient and to the Admission office.

·         Coordinates with the concerned physician if the Insurance Company needs more justification.

·         Enters the approval in the HMIS once acquired.

·         Coordinate with insurance Company if extension of days is needed.

·         Inform the business immediately if the Insurance Company disapproved the extended days or the services.

·         Send to Insurance Company all the cases admitted through ER.

·         Performs additional tasks and duties as assigned by superiors.