Claims Specialist

Claims Specialist is responsible for accurate processing and submission of electronic and paper claims through NPHIES platform, and/or other payers’ categories protocol, complete information and appropriateness of reported services to ensures claims have been managed and submitted in a timely fashion to guarantee payment for services rendered and successful resolution of accounts receivable processes

Primary Duties and Responsibilities

·         All services provided to insurance patients must be Prepared in a defined claim format, submitted to NPHIES in order to reimburse incurred cost from insurance company.

·         Prepare invoices, Collect Claim forms, pre-authorization/approvals forms, prescriptions, radiology reports, laboratory reports and all other medical reports relevant to invoices

·         Responsible to prepare monthly claims “insurance-non insurance” per payer’s contractual terms & protocol of billing and claim upon.

·         Commit to submission timelines and submit claims as soon as it could be to get reimbursed on the soonest occasion.

·         Claim structure must be completed in its all medical, financial forms and supported by all reports and documents.

·         Effectively controls and manages the resubmission process of error and/or rejected claims

·         Provides timely reports to relevant stakeholders

·         Scan, collect all hard copy forms to complete soft copy claims for non-insurance payers

·         Submit original complete claim forms.

·         Print any results from facility system, LIS/HIS needed to complete claim forms.

·         Request and follow up with all concerned stakeholders to gather all lab, radiology results and medical reports needed for attachment to invoices.

·         Attach documents to correlating invoices.

·         Perform comprehensive review of completed claims.

·         Prepare & submit claim report, summary tax invoices each in the corresponding formats to payers

·         Report and defects, challenges or risks that can hider his/her tasks completion in a timely manner

Follow line manager directions and instructions regarding duty hours, vacation schedules, Productivity and assigned tasks …. Etc.