* Obtaining approvals for admission and procedures for emergency and non- emergency cases from Insurance company and Tie-up companies.* Contacting the Insurance and Tie-up Co for verbal approval in case of emergency.* Applying online for e-claims to desired Insurance Co.Admitting the patient is the system with full details.* Maintaining the approval in files for easy access of claims processing and dispatch team.* Review pending cases and follow-up effectively on daily… Show more * Obtaining approvals for admission and procedures for emergency and non- emergency cases from Insurance company and Tie-up companies.* Contacting the Insurance and Tie-up Co for verbal approval in case of emergency.* Applying online for e-claims to desired Insurance Co.Admitting the patient is the system with full details.* Maintaining the approval in files for easy access of claims processing and dispatch team.* Review pending cases and follow-up effectively on daily basis.Identify unusual denials and contact the companies for further justification.* Ensuring the final payment, approvals, co-payment and giving clearance to discharge the patients.* Preparing Inpatient and Outpatient monthly statistics.* Communicate effectively between doctors and Insurance companies when further information is requested.* Coordinate with external and internal clients for approval-related information.* Review the pending cases and follow up effectively on a daily basis.* Establish and maintain the written approval for final records.* To validate the information on all medical claims received.* Working with patient medical records to ensure payment or reimbursement for medical services and reading medical diagnoses, conditions and treatments on patient records. * Training newly hired processors & coders in reimbursement claims processing.*Review the reimbursement claims processed in line as per guidelines and introduce innovative ways to minimize errors and enhance quality standards.* Working on O.P and I.P coding issues and Knowledge of adjudication rules and applying where ever necessary.* Working as a team player in accordance with timeline requirements and production capacity; interact with others in a professional, effective, supportive and productive manner.* Giving regular updates to Managers on all problematic claim issues.* Working independently and Resolving claim adjudication rejections from the reprocess claims. Show less

* Working with problem claims & denials • Getting approvals for medical procedures • Ensuring coverage of claims, guiding staff for correct use age of claim forms, approval papers • Coordinating with insurance companies for obtaining information on new policies and their coverage • Explaining coverage of medical benefits to patients when required • Assisting invoicing department in insurance processing and billing • To network with insurance… Show more * Working with problem claims & denials • Getting approvals for medical procedures • Ensuring coverage of claims, guiding staff for correct use age of claim forms, approval papers • Coordinating with insurance companies for obtaining information on new policies and their coverage • Explaining coverage of medical benefits to patients when required • Assisting invoicing department in insurance processing and billing • To network with insurance companies to obtain accreditation as a provide • To liaise with insurance companies regarding eligibility, payments, approvals, reconciliation and other requirements. • To liaise with patients regarding their eligibility and entitlements. • To train and educate staff in insurance matters. * To advice the management on insurance matters. • To design and implement a protocol for insurance practices in the hospital. • To maintain and update records related to pre-approvals and reconciliation. • To coordinate and co-operate with colleagues of the same department and other related departments for smooth running of Insurance operations. Show less