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