Assistant Manager Sales
Portea Home Health Care
Total years of experience :17 years, 4 Months
• Managing Strategy and Business Development, evaluating new business opportunities and enhancing relations with existing clients
• Finding business opportunities with corporate, industries, institutes, etc.; negotiating price, signing deals and executing the opportunity till the process is stabilized and shows satisfactory improvements and growth.
• Developed an incentive structure for referrers.
• Handling the BTL marketing activities like conducting work-shops, conferences and training programs to increase business and brand awareness.
• Maintaining close contact with top level executives of hospitals, consultants, and various healthcare centers.
• Maintaining professional and technical knowledge by attending educational workshops, reviewing
professional publications, establishing personal networks, participating in professional societies, etc.
• Assisting the provider (US Physician) in navigating the EHR.
• Summarizing the complete medical history of patient and analyzing it for low, medium or high critical health condition.
• Responding to various messages as directed by the provider.
• Maintaining patient health information into the EHR.
• Researching information requested by the provider.
• Detailed review of patients complete case details before visiting hospitals,
• Role is to verify admitted patients case file, discharge summary, pre-authorization form, admission notes etc,
• Confirmation of details are relevant with patient admission and condition of claim Investigations will be focused to verify patient admission requirements relates with complaints of patients in hospital,
• Patients ailment duration of claimed condition and medical history of patient has to be cross checked with patient or with his relatives to justify (PED) pre existence of claimed condition,
• Need to report if any fraudulence in case details to concerned person with necessary hospital documents for rejection remarks and opinion about handled case will be updated on spot,
• Triggers of handling case have to be sorted out properly with justifying evidence based investigated reports for claiming and rejecting case,
• Auditing adjudicated claims and generating SLA Reports of Quality,
• Participating in Daily Meetings with Onshore team,
• Responsible for improvement of Quality of claim adjudication
• Responsible for RCA (Root Cause Analysis) of errors in production,
• Reviewing Errors and taking Error Feedback Session for Adjudication Team.
• Honored with appreciations from client for improving quality from
88-90 to 98% consistently for7+ months.
• Responsible for claims adjudication, analysis & Investigation.
• Processing all types of claims, cashless, reimbursement, health checkup and coordination of benefits between two insurance Policies.
• Detecting the fraud triggers in the claim documents.
• Supporting and mentoring the team for processing difficult claims.
• Clinical Examination of patients.
• Attending, examining and treating patients at primary level in Casualty.
• Assisting surgeons during surgeries and procedures.
• Coordinating with Health insurance companies and TPAs. for health insurance queries.
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