Medical Authorization Executive
Neuron LLC
Total years of experience :5 years, 3 Months
Medical Authorization Executive
Neuron LLC, Dubai, UAE
(Third Party Administrator)
February 2013 - Present
Responsible for providing authorizations or responding to all inquiries, by providing information or directing requests to others who can supply the necessary information or service; Answer all incoming calls related to general enquiries on insurance policies following the Company guidelines and protocols; Handle calls from Hospitals, Clinics, Pharmacy and patients by ensuring a resolution is achieved; Updating the details of every call attended on the system for further references; Daily follow through of Team assignments including incoming faxes or e-mails; Ensure that all out-patient pre-authorizations faxes which require written approval are processed within 24 hours; Assisting medical providers (hospitals/clinics/pharmacies) and customers on the pre-approval follow up cases; To ensure that the Team Senior or the Manager become aware of possible high cost approvals; Participate in the complaint resolution process; Review along with the Operations Manager, Supervisor, Team Leaders Daily Call Reports to assess the adherence to KPI's;
Updating self on the new groups, any amendments to the existing policies, about the addition, renewal and removal of groups for the insurance companies; Updating self on the existing medical knowledge, new medical advancements, new techniques and drugs; Maintain daily log sheets to assess daily performance;
Receive feedback on call coaching and call calibration and learn techniques within the team to better ones performance; Provide support as and when necessary to the Medical Claims Department in assessing claims; Provide medical guidance to the Claims Department staff and assistance in ICD coding; Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction; Processing claim forms, adjudicate for provision of deductibles, co-pays, co-insurance maximums and provider settlements; Entering claims data into the system. Performing audit of randomly selected claims to ensure quality processing and detect any frauds.
Data Entry Team Leader
German Health Consult, Dubai, UAE
(Third Party/Outsource Insurance Company)
January 2011 - January 2013
Checks documents to be encoded by data-entry team; Sets daily target and quota to the team, and runs reports by end of each day which are being discussed and reported to the General Manager. Does quality check of team members completed tasks; Acts as floor support whenever required; answers team's queries regarding data entry or medical document claims; Liaises with the manager regarding operational issues that impact the department at large.
Data Entry Clerk
German Health Consult, Dubai, UAE
(Third Party/Outsource Insurance Company)
December 2009- December 2010
Encodes error-free transactions medical claims, and other documents; Ensures complete supporting documents are attached on each claim; Counterchecks medical diagnoses, compares concurrence with the doctor's prescriptions to prepare documents for data encoding.
Customer Service Representative
Bayan Telecommunication, Inc., Philippines
April 2009 - October 2009
Handles inbound calls and provides information/assistance to customers; Checks mail, fax and email to provide customer assistance; Operates computer/on-line guidelines for the purpose of responding to customer inquiries; Communicates with customer on the phone or via written correspondence to resolve concerns; Resolves customer issues on the first call/contact whenever possible without having to transfer caller; Follows escalation procedures as needed; Completes, processes and maintains applicable paperwork and records; Performs other duties assigned from time to time.
EXAMS TAKEN / CERTIFICATIONS:
Nurses Licensure Exam
Professional Regulation Commission
Manila, Philippines
December, 2008
Bachelor of Science in Nursing, 2008 Centro Escolar University Mendiola, Manila Philippines