About the job
Planning and managing the data entry and claims processing operations of MedNet Egypt in order to ensure the delivery of superior claims handling services to customers within the defined turnaround times (TAT) in accordance with established policies and corporate guidelines in order to support the achievement of revenue targets and overall business objectives, including the batch receiving from the medical providers and dispatching the invoices per payers to them along with the claims bordereaux.
Your Job
- Manage the effective achievement of objectives through setting individual objectives, managing performance, developing staff, and providing formal and informal feedback to maximize overall performance and team motivation.
- Prepare the department budget and monitor areas of unsatisfactory performance to be rectified promptly, and potential performance improvement opportunities are capitalized upon.
- Plan resources, manage and control overall claims processing operations for provider network and insured member direct claims ensuring benchmarks are met regarding the execution of the different steps in the value chain for claims management, proactively reducing cycle time to ensure the provision of prompt services to clients, and thus supporting achievement of the overall goals and objectives and optimum customer satisfaction.
- Supervise the preparation of claims processing reports in a timely and accurate manner, coach and provide on-the-job training. As well as motivate subordinates to identify opportunities for continuous improvement of claims processing systems, improvement of business processes, cost reduction, and productivity improvement.
- Act as an external auditor for claims by Leading/conducting spot-checking as per guidelines, and procedures to ensure appropriate quality assurance of the data entry and claims processing activities.
- Carry out the necessary tasks to ensure that all procedural/technical coding is accurate and report any system issues to the production and technical departments.
- Monitor the efficiency of the IT systems and liaise with the IT Department for changes/modifications/new reports that lead to improved performance, ensuring adherence to automation requirements as per our agreed strategy.
- Ensure functional relationships between internal departments work well via claims settlements and high level of communication and efficient & timely transfer of information takes place during operations.
- Act as the contact person to insurance providers, members, insurance companies, brokers, and account managers for primary insurance companies/groups to ensure that services are provided as per Service Level Agreements designated in the reimbursement processing and reconciliations clarification.
- Ensure compliance with all relevant quality, health, safety, and environmental management procedures and controls across the department to guarantee employee safety, compliance, delivery of high-quality products/services, and a responsible environmental attitude.
Your Profile
- Bachelor's degree of Pharmacy/ Dentistry / Medicine.
- 3-5 years of experience in a similar role.
- Awareness of the medical coding
- Time management skills.
- Database management skills.
- Interpersonal skills
- Team leadership skills
- Problem solving skills.
- Customer orientation skills
