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Medical Coordinator, International Services ( UAE Nationals Only)

National Health Insurance Company - Daman UAE Posted 2018/09/05 10:14:15 Expires 2018-11-04 116 People have applied Ref: JB1001852704 Source: TAMM

Job Description

General Description: Evaluate and process international inpatient and outpatient claims such direct claims, reimbursement claims, IPC claims, etc. Main Duties: • Process and adjudicate the claim in accordance with the adjudication rules and standards adhering to expected daily targets, quality, error rate, TAT and other key performance indicators (KPIs) • Evaluate medical necessity and consistency of diagnosis, procedure and drug codes and descriptions stated on the claims according to accepted medical coding rules and guidelines • Ensure accurate application of contractual prices and discounts (if available), schedule of benefits, correct allocation of benefits, collection of deductibles, co-payments, observance of policy limits, and adherence to claims submission protocols • Perform data entry of provider data as needed • Understand and work with mandated code sets like ICD codes for diagnosis, CPT codes for procedures, IRDRG codes, HCPCS, Drug Codes during adjudication and processing • Verify the presence of authorisation for services requiring prior authorisation • Effectively liaise with and attend to provider, member or other departments’ queries and appeals (answering phone calls, replying to emails etc.) and required information in a timely and professional manner, according to the established guidelines and KPIs • Ensure that the correct exchange rate is applied • Report fraud and abuse of the provider to superiors • Support in training new joiners through shadow training • Contribute in developing, updating and implementing guidelines for evaluation and processing of medical claims according to set policies, procedures and guidelines • Communicate work related issues clearly and effectively with the team members and superiors • Ensure that business decisions and processes are documented in a professional way • Deliver high quality customer service and respect medical and work ethics at all time

Skills

General Description: Evaluate and process international inpatient and outpatient claims such direct claims, reimbursement claims, IPC claims, etc. Main Duties: • Process and adjudicate the claim in accordance with the adjudication rules and standards adhering to expected daily targets, quality, error rate, TAT and other key performance indicators (KPIs) • Evaluate medical necessity and consistency of diagnosis, procedure and drug codes and descriptions stated on the claims according to accepted medical coding rules and guidelines • Ensure accurate application of contractual prices and discounts (if available), schedule of benefits, correct allocation of benefits, collection of deductibles, co-payments, observance of policy limits, and adherence to claims submission protocols • Perform data entry of provider data as needed • Understand and work with mandated code sets like ICD codes for diagnosis, CPT codes for procedures, IRDRG codes, HCPCS, Drug Codes during adjudication and processing • Verify the presence of authorisation for services requiring prior authorisation • Effectively liaise with and attend to provider, member or other departments’ queries and appeals (answering phone calls, replying to emails etc.) and required information in a timely and professional manner, according to the established guidelines and KPIs • Ensure that the correct exchange rate is applied • Report fraud and abuse of the provider to superiors • Support in training new joiners through shadow training • Contribute in developing, updating and implementing guidelines for evaluation and processing of medical claims according to set policies, procedures and guidelines • Communicate work related issues clearly and effectively with the team members and superiors • Ensure that business decisions and processes are documented in a professional way • Deliver high quality customer service and respect medical and work ethics at all time

Education

Paramedical, Nursing, Pharmacy, Midwifery

Job Details

Job Location UAE
Company Industry Insurance
Requirements Employer (Private Sector)
Job Role Medical
Joining Date 2018-11-01
Employment Status Full time
Employment Type Permanent
Manages Others No
Number of Vacancies 2
Job Code 1001852704/2018

Preferred Candidate

Career Level Entry Level
Years of Experience Min: 0
Nationality Uruguay
Degree Bachelor

About This Company

National Health Insurance Company - Daman

Insurance United Arab Emirates www.damanhealth.ae

Daman provides affordable quality healthcare solutions to suit your needs
Specialized Health Insurance services with an emphasis on customer care
The market leader with experienced staff that you can rely on.

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