Insurance Compliance Officer

About the role

Requirements

• Education/ Professional Qualification:
• - Bachelor’s Degree
• - Business Administration, Accounting or Any related field
• Experience:
• - Minimum of five (5) years of experience in claims processing in a health care setting.
• - Minimum of three (3) years medical office experience in billing, accounting or information systems.
• - Minimum of two (2) years supervisory or management experience.
• Professional Licensing / Certification / Training:
• - N/A

Responsibilities

• - Prepare and distribute Ready Reference Table for all companies (Regular and Insurance) policies.
• - Prepare and process all companies (Regular and Insurance) policies for entering in the system after obtaining required administrative and management approvals.
• - Process and enter all companies (Regular and Insurance) policies and information in to S.D Pharmacy system.
• - Provide information and update Patient Services and Nursing Department about summary of all new, updated, and/or modified company and insurance company information after entering in the system.
• - Receive and process modifications, renewals, and cancellation for all companies (Regular and Insurance) for updating in the system.
• - Review and ensure the correctness and accuracy of all companies (Regular and Insurance) data while entering in the system or already entered in the system.
• - Identify companies and insurance companies with exceptional conditions for review of contracts for renewal.
• - Oversee the current status of patient accounts and assist in identifying and resolving billing and processing problems.
• - Analyse billing processes and recommend methods for improvement.
• - Prepare audits on problem accounts.
• - Notify and train staff of significant changes.
• - Advise Director of Business Services of problems and concerns in the department.
• - Supervise assigned personnel. Assist in training, orientation, and performance evaluation.
• - Participate in, and lead person-centered care initiatives undertaken by HMG.
• - Enrich patient experience with compassion, respect and dignity.
• - Performs other applicable tasks assigned within the level of his/her competence as required

Skills

• claims processing
• billing
• accounting
• information systems
• supervisory experience
• policy processing
• contract renewal review
• data accuracy
• auditing
• staff training
• customer service
• healthcare operations
• patient accounts management
• SD Pharmacy system