Manager Case Management
Neuron LLC
مجموع سنوات الخبرة :19 years, 11 أشهر
Major responsibilities include review of active case management admissions, maintaining communication with clients for update of case activity, case direction as requested, handling client emails related to case management ( issues / queries / complaints ), evaluating bills for high cost inpatient admissions, facilitating case coordination, analyzing and evaluating data, managing the team by ensuring service level agreements of the client are met as per agreement, initiating proactive case management approach as per the circumstances, ensuring medical guidelines are being followed and training of prior approval team.
Major responsibilities include supervising prior approval team, assisting the prior approval team for complicated prior approval requests, training the approval team for outpatients and inpatient requests as per medical guidelines, reviewing the approval team performance and quality control, ensuring the KPI for outpatient and inpatient requests, arranging case discussion sessions with the prior approval team, resolving complaints related to prior approvals and queries from Network department, presenting complicated cases to Medical Director, liaison with Medical Policy Department regarding updates in Medical Guidelines and updating Prior Approval Manual as per policy updates.
Major responsibilities include review of complex medical claims submitted by health care providers; provide feedback on complaints raised by providers and members for medical coverage and reviewing medical guidelines and policies.
Approvals of Inpatient and outdoor treatments, Case management of approvals through personal visits to network of hospitals, Claim verifications and fraud detection by surprise visits to hospitals, 24 hour handling of help line services, Emergency approvals and issues for timely provision of healthcare services to the clients, Preparing and analyzing Data regarding average hospital bill in each city, Analyzing claim percentage according to different parameters, Comparison study among claim data pool of all insured companies, Examining average bill of different hospitals, Coordination & negotiation with the hospitals for settling billing issues and other queries, Inspection of New Health Care Service providers.
Handling inpatient / outpatient approvals, 24/7 Helpine, Claims managment, Fraud case detection, Case verifications, Case management and arranging monthly meetings with Network Hospitals.
International pre authorization, claims verification, claims approval .
Case verifications, Claims approval
Lab Investigations at Pathology Department and Lectures + Practicals
setting up and communicating with a network of volunteer doctors; implementing, organizing and monitoring the data collection system, inventory control and management, internal coordination and reporting to the local head office and headquarters in France.
attending indoor, Outdoor and Emergency department
venous cannulation, lumbar puncture, exchange transfusion, newborn resuscitation, cardiopulmonary resuscitation, inpatient, outpatient and emergency department.