Claims Assessor
Provide guidance and assistance to staff responsible for claims processing and collection activities and ensure that service, quality and productivity of the department is met.
Key responsibilities:
Conduct complex claims auditing
Perform detailed claims analyses
Assist with compilation of & Letters of Motivation; from doctors ; clinical notes. Interact with the doctors and medical aid to resolve outstanding claims
Follow up and collect outstanding claims
Upskill the team to resolve complex claim and conduct account analyses
Make recommendations on current process
Work Experience:
5 years as a claim’s administrator, claims assessor, claims manager, specialist nurse
Advanced knowledge of ICD10 codes
Working knowledge of SAMA, CPT rules and guidelines, NHRPL billing codes
Healthcare industry knowledge is essential
Advanced Excel
Excellent verbal and written communication skills
Qualification:
Matric
Essential: Advanced Certificate ICD10 Coding
Beneficial: National Certificate in human anatomy and physiology