Senior Officer - Medical Direct Billing

Overview

Job Purpose : We are seeking an experienced Senior Officer – Direct Billing to join the medical insurance team. The role is responsible for managing and processing direct billing claims, ensuring compliance with policy terms, medical necessity, and regulatory requirements. The ideal candidate will have strong technical knowledge in the field of medical insurance, claims adjudication, and medical coding, while contributing to efficient claims settlement and enhancing providers satisfaction.

Responsibilities

• Process and review direct billing claims from the network providers for accuracy, medical necessity, and policy compliance.
• Validate coding (ICD, CPT, HCPCS) and provider submissions.
• Liaise with providers to resolve discrepancies and gather required information.
• Identify claim irregularities, fraud, or overutilization and escalate as needed.
• Ensure compliance with internal policies, regulations, and benefits.
• Support audits, analyze billing trends, and prepare reports.
• Coordinate with Finance and teams to ensure timely settlements within TAT.
• Mentor junior staff and contribute to process improvements.

Educational Qualifications

Experience

Key Skills

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