Claims Quality Support Officer

 


What we do

The Claims Quality & Support Officer responsible for activities concerned with review and inspection to  apply quality standards for operational claim processes and adjudication.

What you bring

  • Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans;
  • Audit, assess, and monitor providers and payers, to include but not limited to physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc. medical records, and independently codes, and abstracts.
  • Analyze inpatient and outpatient medical records using most current International Classification of Diseases (ICD-9/ICD-10),Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB) and other codes, regulatory and contractual requirements, and generally accepted coding practices.
  • Verify and validate claims documents received through multiple channels to rule out possibility of documentation / coding errors or other inconsistencies that may occur in case of suspected fraud and abuse cases.
  • Special focus and priority will be given to regulatory audit requirements, reports and findings.
  • A summary of findings will be issued on monthly basis through a report, including recommendations on changes to be made, aligned with the Claims Quality Manager
  • Any other task required by the manager, within the scope of Audit and Claims Support

 

What we require

  • Bachelor’s Degree (Medical Degree or Nursing)
  • Minimum 5 years’ experience from Providers/TPA’s in processing/adjusting claims (e.g. ICD-9/10, CPT, HCPC) or Minimum 3 years’ experience auditing experience
  • Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances
  • Legally permitted to work in the country of operations.
    Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills

More Information

Job Location

Only candidates can apply for this job.
Share this job

Allianz

1 2 3 4 5 (0)

About us

Jobs.CareersInGulf.com is the Middle East Gulf leading jobs portal started in 2013 serveing job seekers and employers of UAE, Saudi Arabia, Oman, Qatar, Bahrain and other Gulf countries completely free to search and advertise jobs.

This is a demo store for testing purposes — no orders shall be fulfilled. Dismiss

BESbswy