Accountant

Responsible for processing, reviewing and filing governmental claims

Key Responsibilities / Accountabilities:

• Process governmental claims in a timely manner to ensure prompt and full payment.
• Review and verify governmental claims for completeness and accuracy.
• Compile claims according to government specifications, i.e. claim forms, invoices, investigation results, prescriptions, etc.
• Verify receipt of all invoices, medicine and clinical, received from Patient Services against HisGENx report on a daily basis.
• Notify and follow up with Patient Services on daily basis any invoices, medicine and clinical, that were not received from Patient Services but are listed on HisGENx report.
• Send monthly report to Patient Services Manager for any missing invoices, medicine and clinical, to ensure prompt and complete submission of company and insurance company claims.
• Review medical records to clarify information and answer questions from companies and insurance companies.
• Send letters on rejected claims and answers follow-ups on requests for information.
• Receive and tally information on incomplete claims forms from assigned General Practitioner and forward to Director of Business Services for review and signature.
• Send incomplete claims forms back to medical staff for response and follows up with medical staff to answer promptly.
• Receive and send to medical staff any rejected claims requesting clarification or other information as requested by the companies and insurance companies.
• Resubmit insurance claims that were rejected with appropriate responses to ensure prompt payment.
• Oversee work of nursing staff temporarily assigned to assist Business Services in processing claims.
• Photocopying, filing and faxing.
• Participate in person-centered care initiatives undertaken by HMG.
• Enrich patient experience with compassion, respect and dignity.
• Perform other applicable tasks and duties assigned within the realm of his/her knowledge, skills and abilities.

Bachelor's Degree Business Administration or Commerce major in Accounting
Experience:

Minimum of 6 years experienced as an Accountant in Hospital Accounting
Experience and knowledge of Medical Insurance policies required
Minimum 5 years working experience as Claims Supervisor
ProfeClaims Processing and Recording
Process Claims Payments: Record payments related to claims (e.g., insurance claims, healthcare reimbursements) and ensure they are accurately processed according to policy terms.
Verify Claims: Ensure that claims are legitimate and complete by reviewing supporting documentation (e.g., invoices, medical reports, and proof of loss) before processing.
Track Claims: Monitor the progress of claims from submission through resolution, ensuring all financial transactions related to claims are properly accounted for.
Reconcile Accounts: Reconcile claims-related accounts to ensure that all payments, adjustments, and claims settlements are properly recorded and balanced.
Financial Reporting and Analysis
Prepare Financial Statements: Generate financial reports related to claims, including claims reserves, paid claims, and outstanding claims balances. These reports help management understand the financial impact of claims on the organization.
Analyze Claims Data: Provide analysis and insights regarding trends in claims, identifying potential areas for cost savings, overpayments, or fraud.
Maintain Claim Reserves: Accurately calculate and adjust claims reserves based on claims experience, industry standards, and accounting policies.
Prepare Audits: Assist in the preparation of internal and external audits related to claims, ensuring compliance with accounting standards, regulations, and company policies.