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Medical Claims Adjudicator

2 weeks ago

المملكة العربية السعودية, Saudi Arabia ACCUMED Full time

Medical Claims Adjudicator - Chiefly responsible for achieving and maintaining minimum Denial rates by contributing in market payer, regulator protocols and Denial and Bypass trends analysis. This is aim to achieve in collaboration with Business Rules Analyst position being reported to him. Furthermore, reviewing medical records in order to abstract relevant data to support the creation/maintenance of Rules. THYNK Rules will support billing integrity and provide best practice support through working closely with payers, regulators, and healthcare providers revenue cycle departments to resolve coding/billing issues, Investigating and resolving issues and incidents leading to incompliance with regulatory policies or denials with payers in the market of Saudi Arabia.
**Requirements**:

- Managing Business Rules Analyst and ensuring set targets are achieved.
- Monthly analysis and review of **Remittance reports** across all the payers and simultaneous provision of feedback suggesting updates for the Rule engine thereby decreasing denial trends for the clients and maximising remittance output.
- Monthly analysis and review of **Bypass reports** and simultaneous provision of input to improve rules. Hence, scrubbing and updating quality of Rule engine (THYNK)and optimizing end user experience.
- Analysing potential and new clients remittance reports and protocols.
- Reviewing different trends of analysis thus contributing to automation of Rules engine.
- Contributing in strengthening of THYNK as a complete product offered in markets to its clients.

**Benefits**
- Minimum 4-5 years’ experience in the said field.
- Excellent Analytical skills and an eye for detail is a must.
- Medical Billing knowledge within private healthcare insurance sector required
- Recognised Professional Certification in Medical Coding highly desirable.
- Should be well versed KSA local market regulations like CCHI, Health Council and SEBAHI
- Excellent verbal/written communication and leadership skills
- Proficiency in Healthcare Information Systems and Microsoft Office (Word, Excel, PowerPoint, etc.)
- Bi-lingual Arabic/English preferred
- Medical training as Doctor/Nurse/Pharmacist is highly desirable