Medical Billing Assessor at Jubilee Insurance

Role Purpose

Pricelist Management – responsible for building master charge lists for providers and validation of specific charge category entries.

Responsibilities for the Medical Billing Assessor Job

• Registration of billing information from provider charge lists into a pricing tool
• Validating procedure, treatment, diagnosis and pharmaceutical terminologies
• Keeping track of price adjustments from particular providers
• Auditing of billing irregularities and advising providers on remedial actions
• Highlighting outliers and other areas of concern in provider charge categories
• Liaising with Provider Partnership team on pre-negotiated provider charges
• Participate in Provider Grouping based on differential price levels
• Participate in generation of exceptional reports for management reporting
• Performs other related duties as assigned, which may be inclusive, but not listed in the job description.

Key Deliverables.

• Successful construction of a universal pricing master file
• Identification of key areas for cost-containment intervention

Qualifications for the Medical Billing Assessor Job

• Diploma in Nursing, Clinical Medicine, Laboratory Medicine and Pharmacy
• Good understanding of the concepts of medical insurance
• Proficient in the use of Microsoft office suite and packages.

Functional Skills

• Excellent data analytical skills
• Performance reporting and management
• Health Benefits Plan Management
• Familiarity with medical coding e.g. ICD 10, DSM-5, SNOMED, RxNORM, HCPCS, CPT, DRG etc.
• At least two years of practice in a busy hospital setting.
• Experience in clinical research an added advantage