Audits / Reviews medical claims, medical records and other documentation essential to justify the rejected services rendered to the patient by the healthcare facility.  Ensure that the details of the claims are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
Responsibilities
Review and Audit Medical Claims to ensure their accuracy.
Resubmission of rejected claims
Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payersÂ
Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
Submit the claims with proper codes and format to insurance companies within the stipulated time.
Qualifications
Medical/Nursing graduate from a recognized university.Â
