Quality Assurance Officer

؜ - ؜مصر ؜ -

تفاصيل الوظيفة

We are Allianz Partners. The leader in assistance and insurance solutions in
the areas of international health, assistance, automotive and travel
insurance. Allianz Partners is a global family of over ‎19,000 employees across
‎78 countries. This role is in the International Health part of the business,
which has a number of well-known customer facing brands such as Allianz Care,
Nextcare and Medi24.


The International Health line of business provides international health, life
and disability insurance and services, reinsurance and administration services
to a wide range of customers. These include multinational companies,
intergovernmental organizations (IGOs), non-governmental organizations (NGOs),
private individuals, families and students. Our mission is to ensure that
customers have access to quality healthcare through our support, care and
commitment to go the extra mile. We are a truly global health partner for our
customers, ensuring fast and simple access to the best advice, treatment and
value for our customer.
Summary:
The Quality Assurance Specialist - Review & Evaluation is responsible for
activities concerned with review and inspection to apply quality standards for
operational processes.


Main Tasks:



  • Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans;

  • Audit, assess, and monitor providers and payers, to include but not limited to physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc. medical records, and independently codes, and abstracts.

  • Analyze inpatient and outpatient medical records using most current International Classification of Diseases (ICD-‎9/ICD-‎10),Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB) and other codes, regulatory and contractual requirements, and generally accepted coding practices.

  • Verify and validate claims documents received through multiple channels to rule out possibility of documentation / coding errors or other inconsistencies that may occur in case of suspected fraud and abuse cases.
    Minimum Requirements:

  • Bachelors Degree (MBBS / Pharmacy)

  • Minimum ‎3 years' experience from Insurance / providers in processing/adjusting claims (e.g. ICD-‎9/‎10, CPT, HCPC)

  • Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances

  • Legally permitted to work in the country of operations.

  • Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills


Job Level:
Entry Level
Location:
EG
Available until:
‎07/‎06/‎2023
Area of Expertise:
Operations
Unit:
Allianz Partners
Employing Entity:
Nextcare Egypt
Job Type:
Full-Time
Remote Job:
Hybrid working
Employment Type:
Permanent
ID:
‎26728

ملخص الوظيفة

  • المُعلن : Allianz
  • تاريخ الإعلان : 07/05/2023
  • نوع العمل : -
  • مستوى الخبرة : -
  • المستوى التعليمي : -
  • الراتب : -
  • الهاتف : -

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