EXECUTIVE, CASE REVIEW – KPJ Healthcare

The Executive, Case Review is responsible for verifying patient admission documents and ensuring proper medical documentation for insurance claims. This role involves liaising with medical professionals and insurance companies to facilitate accurate billing and claims processing.

Review and verify patient admission documents, medical reports, and insurance coverage. Liaise with consultants, doctors, and clinical teams to ensure proper medical documentation is available for insurance claims. Coordinate with insurance companies for pre-authorization, guarantee letters, and claims approvals. Ensure accuracy of charges and billing information in the hospital system before submission. Monitor patient length of stay, treatment plans, and approval validity to avoid claim rejections. Assist in resolving insurance queries, disputes, and billing discrepancies.