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Reconcilliation Analyst
2 hours ago
ACCUMED Dubai, United Arab EmiratesDetailed analysis of trends and patterns of rejection during the reconciliation process through evaluation of claims; generation, tallying and maintenance of reconciliation reports for the departments and external and internal communication of the recon data and queries. Overall ...
Reconcilliation Analyst - Dubai, United Arab Emirates - ACCUMED
Description
Detailed analysis of trends and patterns ofrejection during the reconciliation process through evaluation ofclaims; generation, tallying and maintenance of reconciliationreports for the departments and external and internal communicationof the recon data and queries. Overall taking measures to optimizerejection rate and meet individual and departmentalKPIs.
PrimaryResponsibilities:
·Taking measures to optimize the overall rejection rate for aprovider-payer account to below 5%
·Reconciliation of legacy claims with newly contracted clients, therecovered amounts should be based on the assessment of the claimsand rejection percentage to be maximum of25%
· Detailed evaluation of claims,retrospective audit of claims to bifurcate recoverable andnon-recoverable values with 100% accuracy on the grounds ofPayer-Provider agreement and RegulatoryAuthority-Coding-Documentation-Auditing guidelines for negotiationwith payers.
· Solely responsible forverifying claims ready for recon upload, performing the exercise ofupload of claims and compiling data.
·Generation and maintenance of reports for reconciliation, preparereconciliation summary, the claim wise & activity wisereport as per ACCUMED RECON format, to be updatedmonthly
· External: Communicating thenecessary and required data accurately (figures, claim analysis,signoffs etc) between payers and provider as perTAT
· Addressing challenges facedduring reconciliation to the concerned party;Resubmission/IRM/Client/CRM etc in order to avoid future grievancesand take corrective measures