Medical Insurance Approval jobs

1. JOB PURPOSE

The Jobholder need to do network system updates and maintenance related to providers details registration, updating and maintenance on providers information and claims fixing. Tickets screening, Bank Details updates, contracts and addressing complaints on timely manner. The employee will be able to manage independently tasks assigned.

2. RESPONSIBILITIES AND DUTIES

Ø SYSTEM - responsible for providers details registration, updating and maintenance. It is a module being access by the entire NAS Neuron organization as reference for claims processing, approvals and payment preparations. Task details Enumerated as follows;

A. PROVIDER DETAILING (SYSTEM)

1. Provider detailing entry in system (i.e. address, contacts, groupings, currency reference, e-claim code mapping and discount structuring if required)

1. Allocations of provider id’s (in net) & (out net) providers

2. Provider Specialty updates

3. Provider Business information updates including

4. Regular maintenance on Provider information

5. Initiate updating for any changes i.e. termination, suspension existing providers

6. Process linking & delinking of networks and providers

7. Time to time update of data whenever is necessary

8. Daily clinician report downloads for clinician validation tat of 24-48hr

9. Provider Clinician update, review validation and maintenances.

B. CLAIM FIXING CLINICIAN

1. Clinician pending to be updated in system follow with provider.

2. Update the claims pending on clinicians.

Ø PROVIDER FOLDER DATABASE MAINTAINANCE –responsible in maintenances of provider folders for contracts , correspondences and commercial terms and changes

Ø NEW DOCTORS EMPANELMENT AND LIST MAINTENANCE – utilized as reference in giving easy referral to members or clients for a type of doctors field and specialization available to NAS Neuron Network.

1. Doctors list maintenance and send out Request list and update the master file

2. Attending request from provider for the enrollment of new doctors and assist providers to timely submit the list of additional services proposals for the service to be provided by new doctor

3. Assessment of doctors eligibility and sent empanelment confirmation and approval

4. Updates for termination / suspension.

Ø PROVIDER LICENSE CLEAN UP – responsible for regular audits on provider licensure and to ensure provider license details are up to date which is inclusive of provider communication and timely system updates across UAE and GCC providers

Ø PROVIDER TRACKING SHEET – responsible for provider tracking sheets, the providers tracking play important rule as it been utilized by the entire NAS Neuron organization, as reference in sending claims rejection, denial, payment report, broadcast, circulars, memos and other correspondence, this tracking as it contain the providers ID’s, providers grouping, contact persons details, appropriate email ID and or important focal points providers.

Ø ROUTINE & MISCELLANEOUS TASKED

1. Maintenance and routine update such as deletion, adding and changes

2. Assisting inquiries and request for update provider contact point

3. Analysis of received emails and sent out of response for any direct and indirect concerns.

4. Facilitate internal inquiries and other related concern noted in providers details on the system

5. Bank Details updates verification and endorsement to network finance team.

Ø SUPPORT AND EXTENDED TASKED – extended time to time assistance to

1. Sr. Quality and Operation, when on leave and or whenever is necessary particularly in dealing with providers issue and other related concern, notification and broadcast

2. Inclusion Team and Commercial team, to expedite the process of addressing their project and urgent task.

3. Provider Contract & Addendum Draft including end-end provider communication and sign off

4. Provider utilization data collection and review/analysis

5. Maintaining provider relations and schedule regular calls with key providers

6. Arrange and conduct provider trainings across the region in person and online

7. Execute any assigned projects related to provider relations, provider/TPA governance

3. KNOWLEDGE, SKILLS AND EXPERIENCE

· University degree in any discipline of medical/Para medical science from a reputable university.

· Basic industry knowledge (healthcare / insurance).

· Should be a team player

· Excellent oral and written communication skills.

· Must be computer literate.

· Excellent command of the English language, Arabic is a plus.

· Candidate must be tactful and discrete when dealing with providers and must be able to handle confidential information.

· Ability to work under pressure.

· 2+ years’ experience in the healthcare industry / hospitals is preferable but not mandatory.

Job Types: Full-time, Permanent

Pay: AED6,000.00 - AED9,000.00 per month

Work Location: In person