Medical Insurance Manager

Description

Job Purpose / Objective

Responsible for development, performance, governance and administration of the insurance provisions for HMG to produce an efficient service. The position holder will coordination with insurance company and provider, billing and collections to ensure accurate billing and efficient accounts collections.

Key Responsibilities / Accountabilities

• Review status of company, insurance company and provider accounts to identify and resolve billing and processing problems in a timely manner.
• Manage claims operations from regular and insurance companies and government institutions within proper collection ratio.
• Monitor and finalize the claim on or before the target date.
• Ensure the system is controlling the company contract and policies.
• Monitor the number of invoices processed by each claim processors.
• Review before approving the company credit invoices for cancellation / refund.
• Process E claim submission through Waseel System.
• Monitor the daily received policies to be entered in the system.
• Maintain contact with patient services, medical records and other departments to obtain and analyze additional patient information to document and process billings.
• Manage, train orient and evaluate performances over assigned personnel.
• Monitor daily operating activity of department and make necessary adjustments in work assignments.
• Maintain knowledge of and comply with established company, insurance company and provider regulations and policies and procedures.
• Maintain confidentiality in regards to company, insurance company, provider and patient’s accounts status.
• Analyze, evaluate and negotiate company, insurance company, and provider contracts.
• Manage reconciliation and clearance of all claims with all insurance companies.
• Responsible for orientation of all new doctors’ regarding insurance policies and procedures.
• Responsible for the financial, operational and delivery aspects of company, insurance company and provider contracts.
• Oversee compliance with company, insurance company and provider contracts ensure that claims are paid accurately and on time and manage claims payments processes.
• Analyze and report on trends and company, insurance company and provider utilization and referral patterns.
• Coordinate with the Medical Director to identify and facilitate the medical management of company and insurance company patients.
• Maintain strict confidentiality required related to medical records and other data.
• Participate in professional development efforts to ensure currency in health care practices and trends.
• Participate in, and lead person-centered care initiatives undertaken by HMG.
• Enrich patient experience with compassion, respect and dignity. CHRD- Organization Effectiveness
• Perform other applicable tasks and duties assigned within the realm of his / her knowledge, skills and abilities.

Education / Professional Qualification

Experience

Professional Licensing / Certification / Training

Seniority level

Employment type

Job function

Industries

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