JOB DESCRIPTION
Duties and Responsibilities:
- Rejection can be separated into three categories: medical, financial & operational. Medical rejection should be forward to treating doctor (if needed) for explanation & justification of provided services. The Rejection analyst will maintain an Excel schedule showing the position of these justification requests at any given time. For financial & operational rejections: the analyst must obtain the necessary reports, results, justifications, etc. when all justifications and reports have been accumulated, they are entered onto the appeal summary Excel sheet & forwarded to the insurance company after reviewed by Rejection & Reconciliation manager.
- Rejection and suspension details are maintained on Excel spreadsheets where they should be transferred into a defined data available for analysis.
- Ensure that all insurance policies are available to be used as reference for rejection rules and regulations for review whenever needed.
- Performs other tasks and duties within the scope of the knowledge skills and experience required for the job as assigned by the immediate manager or department head.
- Prepare improvement report based on rejections KPI by each department.
- Provide personalized coordinated care, and support for staff and families.
- Treat people with dignity, compassion, and respect.
QUALIFICATIONS:
- Bachelor degree in medical related field.
PROFESSIONAL EXPERIENCE:
- Minimum 2 years experience.
SPECIALIZED SKILLS :
- skills and computer literate.
- Excellent knowledge of English speaking & writing.
- Updated knowledge of all insurance business, CCHI regulations.
