Medical Claims Invoice Assessor
Location
Kingston upon Thames, Greater London | United Kingdom
Job description
To provide members with a professional and timely claims handling service, in accordance with policy terms and conditions ensuring that all decisions and outcomes are reached through accurate and fair assessment of claims.
- Thorough and careful assessment of incoming invoices from consultants, therapists, hospitals and other providers, including managed care invoices, ensuring that all charges are in line with provider contract terms and where no contract is in place that charges are customary and reasonable
- Ensuring surgeon and anesthetist fees fall within the fee schedule
- To proactively challenge accounts that do not adhere to agreements or expectations
- Assessment and settlement of dual insurance and overseas invoices
- A thorough understanding of medical terminology and medical conditions is required to carry this process out to the expected level
- Check a claim form has been received for the appropriate treatment and pre-authorisation obtained
- The confidence and knowledge to make decisions on whether invoices can be settled without a supporting claim form
- Check that invoices have been scanned and indexed correctly via our scanning database (INVU)
- To continually self-develop in understanding the PMI industry in areas such as CCSD codes and to maintain an up to date knowledge of medical terminology and industry jargon
Key Responsibilities
- Accuracy level to be maintained to a high standard
- Excess, co-payment and benefit limits are applied correctly
- Invoices assessed and approved for payment within an internal service standard of 10 working days. The ability to meet individual goals and deadlines
- Invoice discrepancies with providers are logged in appropriate hospital and reconciliation logs
- Supporting the claims administration when required, opening letters and scanning and indexing invoices from providers to INVU
- Speaking to providers to obtain treatment plans or medical reports when required
- Informing members of decisions involving the claims
- Working with the claims department in updating diary notes and giving clear outlines of any changes, decisions or challenges within the claim
- Liaising with the Claims and Correspondence and Managed Care Team where appropriate for thorough claims assessment
- Liaising with other departments, including the provider services, compliance, finance and underwriting as necessary
- Investigating difficult claims and organising pending invoices weekly
- Self generated inbound/outbound telephone work
- Writing bespoke letters specific to the claim being dealt with in a professional manner
Previous experience Medical Invoice Assessing Experience is a must.
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Job tags
Salary
