Sr.Claims Coordinator📣 إعلان

Role Overview

The Sr. Claims Coordinator at National Medical Care Company (Care) in Riyadh is a full-time position dedicated to upholding a superior quality of medical treatment, compassion, and understanding for every patient. This role is central to managing the approval processes for patient admissions and special services with various insurance and direct companies, in addition to executing critical claims-related administrative tasks.

Patient and Service Approvals

• Receive and send approvals to all insurance and direct companies for patient admissions and special services as ordered by physicians.
• Receive answered approvals from insurance or direct companies and convey this information promptly to patients and the Admission office.
• Receive claim forms from nurses or patient relatives for approval purposes, ensuring all necessary ID copy attachments are correct.
• Coordinate with concerned physicians if insurance companies require additional justification for requested services.
• Liaise with insurance companies regarding the need for an extension of patient days.
• Immediately inform the business department if an insurance company disapproves extended days or specific services.
• Send all cases admitted through the Emergency Room (ER) to the respective insurance company for processing.

Claims Verification and Reporting

• Approve and re-check all monthly corporate claims submitted by claims coordinators and clerks.
• Report unadjusted and un-entered medical services to the Claims Manager, including notification of excluded services for newly contracted companies.
• Consolidate all claim rejections and deductions for comprehensive review and action.
• Prepare refunds of payment for services and investigations as per the Claims Manager's instructions.
• Conduct daily checks of in-patient billing for any required adjustments.
• Verify if any services or medication lack appropriate service codes for accurate charging purposes.

Documentation and System Management

• Browse UCAF forms within the system to verify that the encoder has accurately entered requested investigations for admitted patients.
• Prepare and send printed UCAF forms via fax or email to concerned insurance or direct companies.
• Follow up with companies for approval via phone communication.
• Enter all acquired approvals into the Hospital Management Information System (HMIS).

Interdepartmental and External Coordination

• Coordinate with the Accounting section by providing monthly reports detailing amounts payable by contracted companies.
• Participate in drafting contracts with new insurance companies.
• Suggest new computer functions to enhance section performance and operational efficiency.

General Duties

The Sr. Claims Coordinator is also responsible for performing additional tasks and duties as assigned by superiors to support the overall objectives and operations of the claims department.