Medical Claims auditor (Pharmacist Ony) Out Patient

Job Description

• Performing technical audit on medical claims ( outpatient).
• Auditing of invoice and Ensuring that all the medical bills are within the contracted price list and the approval criteria according to Mersal policy.
• Justifying the rejection reasons on system in rejection cases to facilitate the reconciliation process.
• Ensuring the best service given to the patients by providers.
• Report to the direct manager any irregularity or problems noticed during the audit and/or closing of claims.
• Prepares reports by collecting, analyzing, and summarizing information of the reviewed claims to assess the quality of our payment and create a cost effective solution.
• Coordinate workflow & meet deadlines.

Job Requirements

• Bachelor's Degree in Pharmacy.
• Minimum of 1-2 years of experience in reviewing medical claims.
• Details-oriented, Time management & Players.
• Strong communication skills.
• Working knowledge of the MS Office suite (Word, PowerPoint & Excel).
• Previous experience in the field of NGOs will be an added advantage.
• Previous experience in Outpatient Medication