Medical Case Officer at MetroHealth HMO Limited

JOB DESCRIPTION

• Review daily inprocess report for new assigned claims
• Request documentation from Office Assistant needed to complete clinical review of assigned claims
• Review coding of professional bills utilizing requested procedural notes
• Review itemized bill and medical records for medical appropriateness and inconsistencies by performing a line by line clinical review of claim
• Research unfamiliar procedures as needed via web
• Contact provider’s representative to resolve billing issues
• Contact provider’s representative to negotiate claim
• Confirm repricing information with provider
• Provide status of outstanding claims upon request
• Prepare management reports of findings for submission to clients

REQUIREMENTS

•  The ideal candidate must be a registered nurse
• Should posses minium of 2 years experience (HMO experience will be an added advantage)