Medical Claims Processor
National General Insurance
مجموع سنوات الخبرة :7 years, 5 أشهر
Receive calls from both members and providers, answer all the queries efficiently.
Review and provide both approval and query for all OP & IP requests, including pharmacy.
Follow up cases to respective doctors.
Process both OP & IP claims including pharmacy.
• Handles patient scheduling for outpatient and other ancillary department visits, determining appropriate visit type and urgency
• Checks the database for available preferred schedules to meet patient’s first choice for dates and times
• Confirms future appointments as well as any changes to existing appointments over the phone and electronic requests
• Collects insurance and demographic information and updates the system as needed while the patient is still on the phone
• Ensures insurance eligibility.
• Provides non-clinical instructions to patients as needed to help the patients manage expectations if any preparation is needed
• Works collaboratively with nursing and medical departments in coordinating schedules to ensure seamless and positive patient experience
• Responsible for delivering results for key performance indicators as established by the Manager, Scheduling/Director, Contact Center
Responsible in inventories and billings
Operates cash register
Make sure accounts are endorsed well and reported to the supervisor or store manager
Provides good customer service make them feel welcome, lead them to their seat and introduce them to their table attendant.
Trains and evaluate staffs throughout the shift
Initiates company’s new policies
Make reports on inventories daily, store budget, schedules of staffs
Attend customer and staff complaints and resolve accordingly
Maintain accurate, detailed reports and records.
Monitor, record and report symptoms and changes in patients' conditions.
Record patients' medical information and vital signs.
Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.
Order, interpret, and evaluate diagnostic tests to identify and assess patient's condition.
Monitor all aspects of patient care, including diet and physical activity.
Prepare patients for, and assist with, examinations and treatments.
Observe nurses and visit patients to ensure that proper nursing care is provided.
Assess the needs of individuals, families and/or communities, including assessment of individuals' home and/or work environments to identify potential health or safety problems.
Prepare rooms, sterile instruments, equipment and supplies, and ensure that stock of supplies is maintained.
Direct and coordinate infection control programs, advising and consulting with specified personnel about necessary precautions.
Best in Neonatal ICU Practice Registered Nurse , Philippine Licensure- February, 2009