Insurance – Executive

• Responsible to check the Pharmacy Insurance claims

RCM Pharmacy Claims:

• SUBMISREGULAR PHARMACY INSURANCE PROCESS
• Invoicing, Approval & Submission both real time & Riayati/Offline checking
• CLAIMS SUBMISSION PROCESS
• Regularly checking of Portal, claims, Invoice, Plan, Authorization (Real time/off-line), eligibility & Net amount
• Sending corrections (Wrong Plan/wrong receiver/wrong discount/wrong copay) regularly to Pharmacy
• After processing of claims finalize the submission in every 15th & end of the month
• Sending reports after complete finalization to accounts and recon team.
• Uploading to RIAYTI/DHPO after creating payer wise batches
• PAPER CLAIM SUBMISSION TO INSURANCE
• Claims submission (by sending physically)
• By email claim submission to credit companies
• STAEMENT SUBMISSION TO INSURANCE COMPANY (PAPER CLAIMS)/CORPORATE COMPANIS
• SOA sending to insurance company & Credit companies.
• Prepare and send claims for auditing to the insurance company.
• Providing training to new pharmacy staff
• Conducting staff wise correction feedback calls every month and sending minutes of meeting to all Pharmacies.
• Request for IT team to support for create insurance plans, Discount & POS Upation if required.
• Approve or reject the pharmacy request by checking the content.
• (plan/medicine activation/DDC CODE & Discount updating with POS)
• Answering the queries of pharmacy team
• Answering the queries of Network/recon/ resubmission/ accounts Teams

• Diploma/Bachelor or equivalent
• A graduate of Bachelor’s Degree in Allied Health Sciences or related areas
• At least two (2) years of coding experience with valid Certified Coding Associate(CCA) certification from American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) certification from American Academy of Professional Coders (AAPC).
• Must be computer Literate, MS Office.
• Excellent command of oral and written English.
  Performance Criteria:
  Achievement of Core objectives in line with the expectations of the Management and stakeholders
  Ability to work constructively and interact professionally with others
  Ability to coordinate multiple task, adjust to changing priorities and work within deadlines.
  Ability to attend to meetings outside of normal business hours