EXECUTIVE, CASE REVIEW

• 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.

• Prepare and submit required reports to management regarding case status, approvals, and rejections.

• Support the Business Office and Finance Department in ensuring timely and accurate claim submissions.

• Provide guidance and support to patients and families on insurance coverage and claim procedures.

• Maintain compliance with hospital policies, insurance guidelines, and regulatory standards.

• Escalate complex cases to the Accountant/Lead, Business Operations for further action.

• Ensure confidentiality of patient medical and financial information at all times.

EDUCATION

• Minimum Diploma in Business Administration, Accounting, Finance, or equivalent

• Bachelor of Business Administration, Accounting, Finance, or equivalent

KNOWLEDGE AND EXPERIENCES

• At least 2–3 years of working experience in healthcare billing, case review, insurance claims, or related fields.

• Familiar with hospital systems (KCIS/HITS).

• Good understanding of insurance processes, corporate client agreements, and hospital billing procedures.

• Experience in handling audits, case verification, and reporting.

SKILLS AND COMPETENCY

• Strong analytical and problem-solving skills in case verification and billing.

• Excellent communication and interpersonal skills for liaising with doctors, nurses, patients, and insurance providers.

• Competent in Microsoft Office (Excel, Word, PowerPoint).

• Ability to work under pressure and meet strict deadlines.

SPECIAL SKILLS ARE REQUIRED

• Knowledge of medical terminology and coding for billing verification.

• Ability to interpret insurance coverage and entitlements accurately.

• Attention to detail to minimize errors in billing and claims.

• Skilled in preparing accurate reports and presenting findings to management

PERSONAL ATTRIBUTES

• High level of integrity, confidentiality, and professionalism.

• Proactive, meticulous, and detail-oriented.

• Strong sense of accountability and responsibility.

• Team player with leadership potential to guide Case Review Assistants.

• Positive attitude with commitment to continuous learning and improvement