Rcm Officer
1 week ago
Manages insurance approvals for insured patients both Inpatient & out patient. Liaises between NMC Royal Hospital, Sharjah, and Insurance Companies.
- Follows insurance protocols and procedures.
- Coordinates with clinicians and/or other clinical staff for gathering information/documentation for submission.
- Liaises with Insurance Companies/TPAs for submitting, resubmitting, and replying queries raised by Insurance Companies/TPAs efficiently.
- knowledge in pronouncing and understanding medical terminologies.
- Demonstrate strong attention to details and ability to multitask within the fast
- paced, high-pressure work environment.
- Manage and track approval/denials/queries and inform clinicians and patients about the requested service(s) status.
- Prepares cost estimation accurately for approvals as per the agreed terms.
- To maintain an active database of the instructions/communication about Insurance Companies/TPAs from RCM Office.
- Practices professional telephone etiquette both internal and external stake holders while making claim inquires and quickly resolving any patient complaints and concerns
- Provides aid to Front Desk Staff regarding Insurance Protocols and Coverage.
- Maintains strict confidentiality related to medical records and other data.
- Knowledgeable about medical coding guidelines and coding techniques (ICD10CM, CPT, HCPCS).
- Analysing the medical data and entering it in the form of precise medical codes in online portals like e-Claim/DHPO, NeXT Care, Nas, etc. and in the Hospital Management Software.
- Coordinating with claims team for coding updates and updated guiding principles.
- Observing the quality parameters regularly and ensuring that the quality of coding work is maintained at a higher rate.
- Taking pre-approval for in-patient (whenever necessary) & out-patient procedures, laboratory investigations, maternity, dental and optical cases as per the Insurance
- Companies specific coverage.
- Collaborate with doctors and other medical practitioners within the medical team regarding medical conditions that require specific indication on every approval (Inpatient and Outpatient).
- Meet all key performance indicators set for call/claim handling (meet call/claim production call/claim quality, system adherence and attendance, complete call log, manage call reports).
- Reviewing patient’s medical reports, member policy and giving internal approvals wherever necessary without any delay.
- Reviewing the patient's medical history and replying to the queries from insurance companies, whenever there is a delay from the doctor side to reply to the query
- Communicating with the insurance companies and checking with them whenever there is discrepancy in the approved amount (when approval is not as per agreed
- Bachelor’s degree from an accredited college / university. Coding and claims processing skills will be preferred.
- Minimum 2 years’ experience in a similar environment and similar role.
- Knowledge of medical coding, Medical Billing, Insurance Policies and Protocols.
Experience in MS Office
Able to achieve office goals by working efficiently & providing a high level of Patient Services
Communication Skills.
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