Patient Admin Executive

Overview

• **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.
• **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.
• **QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS**
• + Bachelor of Commerce, Business Administration or any other degree.
• Paramedical or coding knowledge will be advantage.
• + Two years minimum of experience.
• + Knowledge of insurance billing procedure.
• + Knowledge in using computer and related software applications.
• + MS Office Experience, Word, Excel and Power point.
• + Extreme organization skills.
• + Communication, interpersonal skills as applied to interaction with co-workers, supervisor and customers.