About the role
Review, Revise and Oversee the workflow with the audit team.Validate and review the processed outpatient claims on I*Geme.Provide any needed support requested by claims processor to ensure and facilitate processing of claimsReport the adjustment reasons and perform any needed additional adjustments on I*Geme.Validate and classify the claims and deductions per provider.Assure the proper application of I*Care by the providers and determine any misuse that might take place.Report missing services or items per provider and any tariff mismatching items regularly.Run the reconciliation report to determine the flagged discrepancies and correct them accordingly.Handle filing and sorting of deducted claims softcopies for all the healthcare service providers according to their categories.Send the adjusted claims to the specified shared folder.Handle the closing of claims on the systemReport and recommend any needed new adjustment reasons to be implemented on the system for the outpatient claims.
BS degree in pharmaceutical Sciences from a reputable university is a must.One year at least of experience in community or hospital pharmacies.One year of experience in TPA industry or claims processing is preferred.Strong medical background.MS Office proficiency and computer literate.Good to very good command of English language.Target-oriented, team player and ability to handle stress.Analytical skills, organizational skills with the ability to handle multiple assignments.Good verbal & non-verbal communication skills.
