- Perform analysis for denials and unpaid claims making appropriate corrections until worked to resolution to include phone call, claims resubmission, appeal, or reconsideration.
- Demonstrate a working knowledge of basic healthcare contractual obligations such as claim filing limits, medical necessity, and dual coverage through Quality Assurance (QA) accuracy and data.
- Ensure expeditious and accurate insurance reimbursement for all Government and Managed Care payors.
- Monitors and audits status of rejections assigned to other areas related pricing, profiling and coding teams
- Audits member liability denials to assure quality of claim determinations and ensures compliance with department plan organization requirements.
- Obtain, manage, and analyze Audit Tracking Report to identify missing records that have not been captured within the system.
Medical Educational background is a MUST Excellent user of Analysis tools ( Excel , power BI , Python ,..)Excellent Communication and Analytical skillsHealthcare insurance background is highly PreferredSaudi Market Background will be an Asset