Claims Reconciliation Specialist

3 weeks ago

dubai, United Arab Emirates Allianz Popular SL. Full time
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Area of Expertise:
Customer Services & Claims
Employing Entity:
NEXTCARE Claims Management LLC
Job Type:
Full-Time
Employment Type:
Permanent
ID:
46596
Claim Reconciliation Specialist is responsible for the end to end and timely (3 -6 months cycle) provider claim reconciliation of rejected claims disputed by the healthcare providers performed as per the regulatory guidelines and as defined within the provider manual and agreement contract with the same. The designated is also responsible to regularly report with all related departments the overall provider claims reconciliation status and suggest improvements (e.g. system or manual adjudication) and identify issues that affect the reconciliation process and to document the lessons learned on every conclusion or closing of provider claims reconciliation exercise including signed clearance letters.Claim Reconciliation Specialist is responsible for the end to end and timely (3 -6 months cycle) provider claim reconciliation of rejected claims disputed by the healthcare providers performed as per the regulatory guidelines and as defined within the provider manual and agreement contract with the same. The designated is also responsible to regularly report with all related departments the overall provider claims reconciliation status and suggest improvements (e.g. system or manual adjudication) and identify issues that affect the reconciliation process and to document the lessons learned on every conclusion or closing of provider claims reconciliation exercise including signed clearance letters.
46596 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent
•
Claims Reconciliation Specialist will conclude every provider claims reconciliation exercise with a signed clearance letter from the healthcare providers for the particular service year properly documented and archived.
- Main Tasks
o
Supervise the Personnel and the activities of the Claims Reconciliation Team and ensure daily productivity and quality targets are defined, monitored and reported to the Manager and Heads and with the senior leadership.
o
Produce Monthly Management Reports with Reconciliation Status (Open and closed) including disputed and payable amount.
o
Liaise with MPM and BD to ensure reconciliations are processed accurately and on time. (Timely Settlement and Timely submission/resubmission)
o
Will directly liaise with MPM and BD to escalate Unresolved or stand-off reconciliation cases for intervention and support to close the reconciliation.
o
Formulate and implement changes and required process improvements not limited to the reconciliation process only but also to the other functions where oversight and discrepancies were identified such as adjudication errors, system errors, un-clear rejection reasons, timeline and technical errors.
o
Handle and support direct communication with the healthcare providers on their rejection ratio and reconciliation review findings.
o
Coordinate with internal and external customers
(Finance, MPM, ACE, BD, MCD, CMD, Payers) as required by the reconciliation process.
o
Communicate and respond externally with Providers and Payers Accurately
o
Carry out claim investigation and review and determine required responses to related queries.
o
Generate required reports to facilitate the reconciliation process
o
Investigate disputed rejected claims and respond with the appropriate justification
o
Facilitate coaching and feedback meetings with stakeholders (external and internal) related with
the reconciliation requirements
o
Conduct Reconciliation meetings with the stakeholders as required by the reconciliation process.
- Main Requirments
•
Bachelor’s Degree; Paramedical background
preferred with medical coding.
•
3
+
years filing/documentation experience. Experience within the Health Care Industry, TPA’s, insurance companies,
Hospitals,
Medical Centers is a plus.#J-18808-Ljbffr

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