Medical Officer- Non clinical (Pune)

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER

PURPOSE OF ROLE:

Designation : Medical Officer/Consultant
Function : Claims PA/RI Approver Reporting to : Assistant Manager ClaimsLocation : PuneEducational Qualification : BHMS, Bsc Nursing , BAMS, BPT, BDS, B. PharmaShift : Rotational Shift (for female employee shift ends at 8:30 PM) Week offs : 6 rotational week offs Provided per month Management Level : Junior Management Level Industry Type : Hospital/TPA/Healthcare/Insurance

Roles and Responsibilities :

• Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
• Scrutinize the claims, as per the terms and conditions of the insurance policy
• Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc.
• Understand the process difference between PA and an RI claim and verify the necessary details accordingly.
• Verify the required documents for processing claims and raise an IR in case of an insufficiency.
• Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff.
• Approve or deny the claims as per the terms and conditions within the TAT.
• Handle escalations and responding to mails accordingly.

Key Results and Outcomes driven by this role:

• Error-free processing (100% Accuracy)
• Maintaining TAT
• Productivity (Achieve the daily targets)

Relevant Experience : 0- 5 years
No of years of experience : 0-5 years

If interested, please share your CV on:

Mail: abhilasha.dutta@mediassist.in

Whatsapp: 8050700698