- Location
- KPJ BANDAR MAHARANI SPECIALIST HOSPITAL, Malaysia
- Type
- Full-time
- Education
- Bachelor
- Source
- Workday
Description
Job Description:
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
