Job Description

Role Purpose
The main role of a medical claims processing clerk is to get patients’ paperwork through our system more efficiently, check for claim forms completion plus accuracy and submitting forms to health insurance companies in order to reduce rejections and returned claims. The main aim is to ensure that maximum revenue is collected from the health insurance companies and as such a health insurance claims processing clerk should pay top attention to detail.

Job Responsibilities

• Check claims for accuracy and completeness prior to the accounts department entering the database
• Submit each insurance claim after verification for final processing
• Analyse and pinpoint which clinics are making the most mistakes
• Analyse and pinpoint the most common errors
• Confirm that the patient and the treatment or prescription are covered parts of the insurance plan
• Review forms or related documents to ensure that all necessary information is available
• Identify missing information and return all incomplete claims to the responsible centres for corrections. If a claim cannot be corrected and is regarded as a loss, they need to indicate and charge it to the responsible centre.
• Ensure that inputs on the claims are accurate
• Add or adjust billing codes where necessary
• Follow all required medical privacy laws when discussing private information about patients with centre managers or other staff members
• Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
• Protects operations by keeping claims information confidential
• Prepares reports by collecting, analysing, and summarizing information.

Qualifications, Skills and competencies
• A nursing/Clinician Diploma or equivalent required
• A qualified clinician/ Nurse with bachelor’s degree will have an added advantage
• Have at least 5 years working experience as a Clinician/Nurse
• Verbal and written communication skills
• Familiarity with insurance billing codes and ability to find and fix errors
• Planning, Organization and exceptional time-management skills with a capacity for multitasking
• Proficiency with office and electronic communication software
• General math skills
• Documentation skills
• Data entry skills
• Knowledge in accounting
• Proficiency in Microsoft Office
• Communication skills
• Analytical skills
• Statistical Analysis

Contract start date
The Medical claims processing clerk will be hired on a temporary basis and will be required to start performing their duties from the 22nd of June 2020. He/she will only have 6 working days per month, 3 days every fortnight

Reporting Line
Required to report directly to the Insurance and Corporate Liaison Manager and will also work hand in hand with the centres and the finance department

If you are interested in any of the above Positions and you meet the above requirements, please, send your curriculum vitae and cover letter including names and contact details of at least three traceable referees as follows:

• One reference from your current or most recent employer
• One reference from your previous employer
Or
• One reference from your last employer and
• One reference from your last but one employer

All applications should be addressed to:

The Human Resource Director
Banja La Mtsogolo
P.O. Box 1854
LILONGWE.
E-mail: [email protected]; to reach him not later than Saturday 27 June 2020.