Manager-Insurance/RCM
Armada healthcare group
Total years of experience :16 years, 7 Months
Lead Insurance operations - Handling Claim processing, submission, re- submission and Reconciliation, Preauthorization. Monitor critical areas such as Medical coding, Insurance billing, preauth-TAT, clean claim submission, Denial Management and customer handling.
Team building, Maintain quality indicators (Error rate, Rejection rate, TAT), analyzing variances, initiating corrective actions, problem solving, regular training & orientation of employees on different process like Approval, claim verification & processing, reconciliation, E-Claims, and DRG system etc. Coordinating and enforcing policies, developing standard operating procedures, and maintain productivity standards, work for the results. Continuous user feedback, improvement suggestions on HIMS/RCM software to improve software and end user experience.
Networking with Insurance companies and TPAs, Developing Business plan, innovative strategies to increase insurance business, Negotiation. Liaising directly with insurance companies for Empaneling contractual agreements, upgrade, renewal of insurance networks & Negotiating on discount structures.
Handled medical claims processing and management, onsite provider audit for quality adherence, FWA analysis & for High cost cases.Proficiently managed Medical claims cost containment through various measures resulted in 10+ M AED cost saving to company. Handled Preauthorization decision making for hospitalization claims, Medical opinion, Validation and Assistance for insurance claims, reporting frauds.
Effectively provided client support, Build and promote long lasting client relationships by establishing a professional network to drive the business further. Provide leadership to the team members and conduct training sessions for them to keep their skill levels up-to-date.
Oversee clinic operations and staff duties. Managed the clinic's budget, billing system, and inventory. Liaised with healthcare professionals and patients about treatment plans. Developed procedures to deliver optimal patient care.
Performed the hiring, training, and performance evaluation of staff members.
Managed internal and external communications and answering queries about the clinic.
Examination, Diagnosis, and treatment of the patient for various illnesses
Arranged various health care camps in the community to spread health awareness as well to assess disease prevalence. keeping up to date with medical developments, new drugs, treatments and medications.
Successfully handled clinical and public healthcare operations in designated area. Administered various public health programs as per state, government of India and WHO guidelines with successful outcome of reduced maternal and child mortality rates in given rural area. Evaluated existing public health & medical programs as well as health services; and suggested enhancements implementations for the different
departments.
Planned adequate medical care and satisfaction of patients. Planned and implemented various health and awareness activities which resulted in increased community awareness, reduced communicable & non communicable disease. Provided leadership to medical and paramedical staff and integrated their efforts to Optimize productivity. Using information systems to manage information and financial data, and
to analyze and measure performance.
Medical examinations of in and out-patients; diagnoses and Prognoses; daily ward rounds; maintains up-to-date case records and making necessary medical reports;
Performing various administrative tasks in different Departments of Hospital;
Administration of Urology outdoor patients (opd’s) & indoor patients (ipd’s). Handled O.P.D patient management, patient follow ups, indoor patient management, pre & post operative management, hospital-patient relationship, Cost management, urosurgical camps management & take overall care to ensure smooth running of department;
Referred patients to professional superiors and concerned physicians for more detailed attention, as may appear necessary;
PGDHHM
B.H.M.S