Medical Direct Billing

2 weeks ago

Muscat, Muscat, Oman Consulture Search Full time 40,000 - 60,000 per year
ONLY FILIPINO NATIONALS NEED APPLY

Job Purpose:

We are looking for an Officer Direct Billing to join our clients medical insurance team. The role is responsible for reviewing and processing direct billing claims, ensuring compliance with policy terms, medical necessity, and regulatory standards. The ideal candidate will have strong technical knowledge in the field of medical insurance, claims adjudication and medical coding, while contributing to efficient claims settlement and enhance providers satisfaction.The ideal candidate will have sound knowledge of claims adjudication and medical coding, supporting accurate and timely claim settlements.

Key Responsibilities:

  • Review and process direct billing claims for accuracy, necessity, and policy compliance.
  • Verify medical coding (ICD, CPT, HCPCS) and provider submissions.
  • Coordinate with providers to clarify discrepancies or missing documents.
  • Identify claim irregularities and escalate potential fraud or misuse.
  • Ensure adherence to company policies, benefits table, and regulatory standards.
  • Support audits and reporting to track claim trends and anomalies.
  • Collaborate with Finance and internal teams for timely settlements of payments to the providers within the agreed TAT.

Educational Qualifications:

Bachelors degree in Allopathic medicine, health science, Pharmacy, Physiotherapy, Nursing, Dentistry, or a related medical/paramedical field.

Experience:

  • Minimum 2 years of experience in medical claims processing, direct billing, or health insurance.

Key Skills:

  • Knowledge of medical treatments, billing procedures, and terminology.
  • Ability to review claims and validate coding accuracy.
  • Strong communication skills for provider and team coordination.
  • Attention to detail and accuracy in claims adjudication.
  • Analytical skills to detect irregularities or misuse in claims

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