ADMINISTRATIVE ASSISTANT

Description

Job Summary: Hospital Claim Analyst responsible for analyzing, verifying, and managing health insurance claim forms and authorizations to ensure procedural compliance. Key Highlights: 1. Experience in analyzing and releasing medical claim forms and authorizations. 2. Handling pending items and coordinating with responsible departments. 3. An opportunity for those seeking a career in healthcare and public service. **Job Description:** * Perform duties related to the Claim Center, including reviewing pending cases to identify potential irregularities prior to claim form release; * Receive and verify claim forms, ensuring they are fully and correctly completed; assess whether initial authorizations have already been approved per each insurer's rules, and coordinate with relevant departments as needed for resolution; * Verify that the claim form screen is correctly populated with authorizations granted by the health plan, and update the claim form screen with newly granted authorizations according to requests; * Monitor pending insurer authorization responses, contacting insurers via phone or email within predefined timeframes; * Review hospital bills to confirm that performed services match requested services and that all services are authorized by the health plan; **Requirements:** **Mandatory:** * Completed High School education; * Proficiency in Microsoft Office suite; * Experience in customer service; **Desirable:** * Higher education degree; * Knowledge of ANS coverage rules and health plan fee schedules for billing medical procedures; * Understanding of health plan rules; * Experience in customer service within a hospital environment;