Claims Coordinator "Makkah"

Job Overview

The Claims Coordinator "Makkah" plays a pivotal role in ensuring the efficient and accurate processing of claims for all patients. This position requires a meticulous approach to claims management, coupled with the ability to supervise and train new team members. The Claims Coordinator will act as a liaison between various departments to resolve discrepancies, verify documentation, and ensure compliance with payer regulations. Additionally, the role involves reporting unadjusted services, suggesting system improvements, and collaborating with multiple stakeholders to streamline claims processing workflows.

Key Responsibilities

• Claims Processing and Quality Assurance: Ensure that all claims are submitted with superior quality and within the acceptable timeframe. This includes verifying the accuracy of claim forms, ensuring attached ID copies are correct, and confirming that all required documentation is complete before submission.
• Departmental Coordination and Communication: Review discrepancies between Emergency Room (ER) and Outpatient Department (OPD) records and communicate findings to the relevant departments. Facilitate the resolution of issues by collaborating with the Admission Office, Billing Department, and PSD (Patient Services Department) to obtain necessary approvals and clarifications.
• Training and Supervision: Conduct training sessions for new Claims Coordinators to ensure they are well-versed in company policies, claim processing procedures, and system functionalities. Provide ongoing support and guidance to enhance team performance and efficiency.
• Reporting and Documentation: Identify and report unadjusted and un-entered medical services to the Manager of Claims. Notify the manager of excluded services for newly contracted companies to ensure transparency and compliance. Maintain accurate records of all communications and actions taken regarding claims processing.
• Process Improvement: Proactively suggest new computer functions or system enhancements to improve the performance and efficiency of the claims processing section. Stay updated with the latest advancements in claims management technology and regulatory requirements.
• Task Execution and Flexibility: Perform additional tasks and duties as assigned by superiors to support the overall objectives of the Claims Department. Adapt to changing priorities and workload demands while maintaining high standards of accuracy and professionalism.

Reporting Structure

The Claims Coordinator "Makkah" will report directly to the Claims Manager, ensuring alignment with departmental goals and objectives. This role requires close collaboration with the Claims Manager to address challenges, optimize processes, and achieve operational excellence.

Qualifications and Requirements

• Education: Preferably a College Graduate or Bachelor of Science in Business Administration, with a major in Management. This educational background provides a strong foundation for understanding claims processing, regulatory compliance, and operational management.
• Experience: A minimum of three years of experience in the claims processing field is required. This experience should include hands-on involvement in claims submission, verification, and resolution, as well as familiarity with payer regulations and medical terminology.
• Competencies and Skills:
  • Language Proficiency: Fluency in both English and Arabic, both written and verbal, is essential for effective communication with diverse stakeholders and ensuring accurate documentation.
  • Technical Proficiency: Proficiency in Microsoft Office Suite (Word, Excel, Outlook) is required. Familiarity with claims processing software and electronic health record systems is a plus.
  • Medical Terminology: A solid understanding of medical terminology is necessary to accurately interpret and process medical claims, ensuring compliance with clinical documentation standards.
  • Regulatory Knowledge: Expertise in payer regulations, including government and private insurance guidelines, is critical to ensure claims are processed in accordance with legal and contractual requirements.