Patient Admin Executive
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• DUTIES AND RESPONSIBILITIES
• Verify the items in the open bills according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, rate plan etc. Ensure that the bills are finalized in compliance with the contractual terms and price agreement.
• Finalize all codified credit bills for batch/statement generation based on the submission cycle (e.g., weekly, monthly etc). In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc and confirm the bill.
• In the case of insurance claims, prepare the xml batch for the finalized claims and validate in the regulator’s portal. Correct errors if any. In the case of corporate and individual payers prepare statement of claims for the period.
• In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc.
• Ensure that the claims are appropriately dispatched by receiving the acknowledgement slip or verifying the regulatory post office with facility license number.
• Can prepare required monthly reports upon request.
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
Requirements
- •Verify open bills against TPA/payer, member ID, card validity, coverage, approvals/LPO, insurance plan, and rate plan.
- •Ensure bill finalization complies with contractual terms and price agreements.
- •Finalize credit bills for batch/statement generation.
- •Process pharmacy claims, verifying transactions and refunds.
- •Prepare and validate XML batches for insurance claims in the regulator's portal.
- •Correct any errors in claim processing.
- •Prepare statements of claims for corporate and individual payers.
- •Dispatch claims and obtain acknowledgements or verify with regulatory post office.
Responsibilities
- •Verify billing details against payer and insurance policies.
- •Manage the finalization of credit and insurance claims.
- •Process pharmacy and medical insurance transactions.
- •Prepare and submit claims through the regulator's portal.
- •Generate periodic statements of claims.
- •Maintain accurate records and acknowledgements for dispatched claims.
- •Prepare monthly reports as requested.
- •Perform other duties assigned by HOD.
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- Find out if NMC Healthcare's ATS is filtering your CV
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60 seconds. $3.99 one-time.
NMC Health is one of the largest private healthcare providers in the UAE. It operates hospitals, day surgery centers, and clinics across the country.
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