Insurance Submission Officer
4 months ago
**Job Summary**:
The Insurance Submission and Reconciliation Officer with Coding Experience at ZIA Medical Center is responsible for the accurate preparation, submission, and reconciliation of insurance claims. This role requires expertise in medical coding to ensure that all claims are coded correctly and in compliance with applicable regulations. The officer will manage claim denials, discrepancies, and work with various stakeholders to optimize revenue cycle processes.
**Key Responsibilities**:
**Insurance Claims Submission**:
- Prepare, verify, and submit insurance claims accurately and timely using proper coding guidelines (e.g., ICD-10, CPT, HCPCS).
- Ensure all submitted claims are compliant with insurance policies, industry standards, and government regulations.
- Handle both electronic and paper submissions for various types of insurance, including private health insurance, government schemes, and corporate insurance plans.
**Medical Coding**:
- Assign correct medical codes to diagnoses, procedures, and services provided, ensuring compliance with coding standards.
- Review patient medical records and documentation to ensure accurate and complete coding.
**Reconciliation of Accounts**:
- Regularly reconcile insurance payments with submitted claims to ensure accuracy and completeness.
- Identify discrepancies between billed amounts and payments received, and take necessary actions to resolve issues.
- Coordinate with the finance and billing departments to ensure accurate posting of payments and adjustments.
**Denials and Rejections Management**:
- Analyze denied or rejected claims to identify reasons for denial and implement corrective actions.
- Resubmit corrected claims with accurate coding and documentation to insurance companies for reconsideration.
- Maintain detailed records of all denied claims and ensure timely follow-up until resolution.
**Coordination and Communication**:
- Work closely with healthcare providers, billing staff, and insurance companies to resolve coding and claim-related issues.
- Communicate effectively with patients regarding their insurance coverage, claim status, and any required out-of-pocket payments.
- Provide coding guidance and training to medical and administrative staff as needed.
**Compliance and Documentation**:
- Ensure compliance with local healthcare regulations, coding standards, and internal policies.
- Maintain thorough and accurate records of all insurance transactions, coding updates, submissions, payments, and reconciliations.
- Prepare and present regular reports on claims status, coding accuracy, reconciliations, and outstanding issues to management.
- **Process Improvement**:
- Identify opportunities for improving the insurance submission, coding, and reconciliation processes.
- Work with relevant teams to implement changes that enhance efficiency, reduce claim denials, and improve revenue cycle outcomes.
**Qualifications**:
- Bachelor’s degree in Health Information Management, Medical Coding, Finance, Healthcare Administration, or a related field.
- Certification in medical coding (e.g., CPC, COC, CCS) is highly preferred.
- Minimum of 2-3 years of experience in medical billing, insurance claims submission, medical coding, or healthcare revenue cycle management.
- Strong knowledge of medical coding standards (ICD-10, CPT, HCPCS), insurance claim submission processes, and reconciliation procedures.
- Proficiency in healthcare billing software, electronic medical records (EMR) systems, and Microsoft Office Suite (Excel, Word, etc.).
- Excellent analytical, problem-solving, and communication skills.
- High attention to detail and the ability to manage multiple tasks effectively.
- Familiarity with local healthcare regulations and insurance practices in the UAE is an advantage.
**Skills**:
- Strong organizational and time management skills.
- Effective communication and interpersonal skills for dealing with insurance companies, patients, and staff.
- Ability to work independently and collaboratively within a team environment.
- Proficient in English; knowledge of Arabic is an advantage.
Pay: AED5,000.00 - AED7,000.00 per month
**Experience**:
- Submission / Resubmission: 2 years (required)
License/Certification:
- Medical Coding Certificate (required)
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