Wednesday 22 August 2012

Jobs at AAR Health Services (U) - Medical Claims Assesor Job Vacancy


Job Title: MEDICAL CLAIMS ASSESSOR

Job Description

There is a vacancy for the above position.

Purpose of the position:

This position is responsible for assessing claims for validity in terms of Scheme Rules and Regulations, using discretion and a degree of reasoning to be able to make a choice whether to accept or reject the claim.

KEY RESULT AREAS
• Confirm membership number, Service Provider’s practice number. Ascertain whether membership and Service Provider’s number are valid and corresponds with the names of claim documents.

• Check the Service Provider’s claims history.

• Determine what is settled and what must be processed for payment.

• If there is a book keeping error reflected on the claim the assessor must place the claim on hold to the Medical Claims Administrator.

• Assessor must at this stage apply the necessary pending/rejection reasons and place notes

• These rejections will in future generate system letters. In the event that a system generated letter is not available, the Assessor should produce a letter as per pre-determined format

• All letters are attached to the appropriate rejected claims and sent to the Claims Administrator for checking and signing

• Respond to benefit and account queries by writing a letter or with a telephone call

• Respond to internal queries and handling of erroneous payments

DUTIES INCLUDE
• Capture claims master information: received date, dates of service, authorization number (if claims was pre-authorized), member number, service provider number, payee type, diagnosis.

• Capture Claim details/line information: tariff code, claimed amount, quantity, adjustments, discounts, levy

• Capture claims reference information: Batch number, invoice date and referral number (id claims is a referral)

• Confirm that claim has been processed against right benefit type

• Apply the scheme rules when capturing a claim

• Identify claims to be placed on hold and refer to the appropriate staff of authority for investigation. These claims are handed back to the assessor for processing once the investigation is completed

• Detect any fraudulent charges e.g. duplication of services, overpricing of items/medicines and changing of dates

• Claims Assessor must at this stage indicate the necessary rejection statements e.g. duplication of services, charges outside normal trend, overpricing of medicines etc.

KEY PERFORMANCE MEASURES
• 100 lines of Hospitalization claims assessed in 8.5 hours

• 200 lines of outpatient claims assessed in 8.5 hours

• Timely and accurate processing of claims based on pre-determined standards

• Claims should be ready for payment not later than 5 days from date received

• Handling of client queries completely and accurately first time round

• Efficient and accurate problem solving

• Satisfied members and suppliers of service and scheme

LEVEL OF EDUCATION AND EXPERIENCE
 Registered nurse
 ICT Competency

OTHER COMPETENCIES
• Proven team player, good inter-personal skills, and ability to build personal and impartial relationships.
• Posses strong communication, administrative and customer service skills.
• Confidentiality.


How to Apply

If you meet the above requirements, kindly forward your application letter with the attaching documents to the HR Office or email hr@aar.co.ug by latest 7th September 2012.