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NMC Healthcare is one of the largest private healthcare networks in the United Arab Emirates, and the third largest in Oman. Since 1975, we have provided high quality, personalised, and compassionate care to our patients and are proud to have earned the trust of millions of people in the UAE and around the world. |
SUBMISREGULAR PHARMACY INSURANCE PROCESS
Invoicing, Approval & Submission both real time & Riayati/Offline checking
CLAIMS SUBMISSION PROCESS
Regularly checking of Portal, claims, Invoice, Plan, Authorization (Real time/off-line), eligibility & Net amount
Sending corrections (Wrong Plan/wrong receiver/wrong discount/wrong copay) regularly to Pharmacy
After processing of claims finalize the submission in every 15th & end of the month
Sending reports after complete finalization to accounts and recon team.
Uploading to RIAYTI/DHPO after creating payer wise batches
PAPER CLAIM SUBMISSION TO INSURANCE
Claims submission (by sending physically)
By email claim submission to credit companies
STAEMENT SUBMISSION TO INSURANCE COMPANY (PAPER CLAIMS)/CORPORATE COMPANIS
SOA sending to insurance company & Credit companies.
Prepare and send claims for auditing to the insurance company.
Providing training to new pharmacy staff
Conducting staff wise correction feedback calls every month and sending minutes of meeting to all Pharmacies.
Request for IT team to support for create insurance plans, Discount & POS Upation if required.
Approve or reject the pharmacy request by checking the content.
(plan/medicine activation/DDC CODE & Discount updating with POS)
Answering the queries of pharmacy team
Answering the queries of Network/recon/ resubmission/ accounts Teams
Qualifications
Diploma/Bachelor or equivalent
A graduate of Bachelor’s Degree in Allied Health Sciences or related areas
At least two (2) years of coding experience with valid Certified Coding Associate(CCA) certification from American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) certification from American Academy of Professional Coders (AAPC).
Must be computer Literate, MS Office.
Excellent command of oral and written English.
Performance Criteria:
Achievement of Core objectives in line with the expectations of the Management and stakeholders
Ability to work constructively and interact professionally with others
Ability to coordinate multiple task, adjust to changing priorities and work within deadlines.
Ability to attend to meetings outside of normal business hours
Invoicing, Approval & Submission both real time & Riayati/Offline checking
CLAIMS SUBMISSION PROCESS
Regularly checking of Portal, claims, Invoice, Plan, Authorization (Real time/off-line), eligibility & Net amount
Sending corrections (Wrong Plan/wrong receiver/wrong discount/wrong copay) regularly to Pharmacy
After processing of claims finalize the submission in every 15th & end of the month
Sending reports after complete finalization to accounts and recon team.
Uploading to RIAYTI/DHPO after creating payer wise batches
PAPER CLAIM SUBMISSION TO INSURANCE
Claims submission (by sending physically)
By email claim submission to credit companies
STAEMENT SUBMISSION TO INSURANCE COMPANY (PAPER CLAIMS)/CORPORATE COMPANIS
SOA sending to insurance company & Credit companies.
Prepare and send claims for auditing to the insurance company.
Providing training to new pharmacy staff
Conducting staff wise correction feedback calls every month and sending minutes of meeting to all Pharmacies.
Request for IT team to support for create insurance plans, Discount & POS Upation if required.
Approve or reject the pharmacy request by checking the content.
(plan/medicine activation/DDC CODE & Discount updating with POS)
Answering the queries of pharmacy team
Answering the queries of Network/recon/ resubmission/ accounts Teams
Qualifications
Diploma/Bachelor or equivalent
A graduate of Bachelor’s Degree in Allied Health Sciences or related areas
At least two (2) years of coding experience with valid Certified Coding Associate(CCA) certification from American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) certification from American Academy of Professional Coders (AAPC).
Must be computer Literate, MS Office.
Excellent command of oral and written English.
Performance Criteria:
Achievement of Core objectives in line with the expectations of the Management and stakeholders
Ability to work constructively and interact professionally with others
Ability to coordinate multiple task, adjust to changing priorities and work within deadlines.
Ability to attend to meetings outside of normal business hours
