EXECUTIVE, CASE REVIEW – KPJ Healthcare

The Executive, Case Review is responsible for reviewing and verifying patient admission documents and medical reports for insurance claims. This role involves liaising with various healthcare professionals and insurance companies to ensure accurate documentation and billing processes.

In this role, you will engage in daily interactions with consultants, doctors, and clinical teams to ensure that all necessary medical documentation is available for insurance claims. You will also coordinate with insurance companies to manage pre-authorizations and claims approvals, ensuring a smooth billing process.

Key Responsibilities:

• Review and verify patient admission documents and medical reports.
• Liaise with consultants, doctors, and clinical teams for proper documentation.
• Coordinate with insurance companies for pre-authorization and claims approvals.
• Ensure accuracy of charges and billing information in the hospital system.
• Monitor patient length of stay and treatment plans to avoid claim rejections.
• Assist in resolving insurance queries and billing discrepancies.
• Maintain up-to-date knowledge of medical terminology and coding for billing verification.