Insurance Coordinator
1 month ago
Primary Responsibilities:
- Preapproval for claims requiring approval.
- Monitoring and follow up on prior authorization for outpatient services.
- Evaluate the Pre-Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules.
- Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.
- Respond to Insurance/ TPA queries adequately and liaise with concerned department without any delay.
- Submission claims - XML file for all insurance companies in a timely fashion in line with claims adjudication rules of DHA and Riayati
- Verify the ICD10 CM codes and relevant CPT/HCPCS codes on the claim forms for submission to various insurance companies on day-to-day basis.
- Coordinating with Insurance, Doctors and Billing for E-claim Submission, Resubmission
Skills Required:
- Strong medical background to handle reconciliation efficiently.
- Good decision-making skills
- Ability to work under pressure to achieve target.
**Experience**:
- Minimum 1+ years’ experience in a similar role
**Education**:
- Medical or Nursing Background
- CPC Certification optional
**Experience**:
- Submission and Pre approval: 1 year (required)
**Experience**:
- Nursing or medical background: 1 year (required)
- Submission and pre approval: 1 year (required)
License/Certification:
- CPC certification
- optional but preferable (preferred)
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