Insurance Health care provider relationship manager
Liberty
Total years of experience :17 years, 11 Months
• Detailed Responsibilities
- Health Care provider Contracting and acreditatation around Zambia in line with Liberty Health guidelines and protocols
- Provider Claims analysis for purposes of investigating any possible fraudulent trends.
- Conducting inspections of contracted providers all round Zambia to ensure adherence to the agreed service level agreements
- Financial and Claims reconcilliations with health care providers
- Ensuring Provider Payments are made in the agreed Time frame
- Contineous Couching and Training of health Care Providers on Liberty Processes and Policies to ensure the providers do everything as per agreed standards and avoidance of any fraudulent activities.
- Ensuring our clients are given the most appropriate and cost effective Health care from our health care providers
- Ensuring that our clients are always attended too by the health care providers by making sure that benefits are not depleted through overservicing by our health care providers
Responsibilities
• Provider Network Management
- Provider relations
- Provider Accreditation
- Tariff/ Price Negotiations
• Case Management
- Benefit Management
- Pre-Authorization Process Management
- Patient Evacuation Management
- Chronic Disease Management
• Risk Assessment Monitoring
- Identifying, monitoring and rectify specific business risk
- Shortfalls Management
- Quality Assurance
Duties:
• Assessing Medical claims from all health care providers around Zambia Before payment is done.
• Quality control on the claims received from HCPs
• Authorising Payment for pre admissions to hospitals
• Answering to some queries from health care providers and patients when they phone in.
• Writing reports about the operations in Claims Department
Duties:
- Enrolment of clients who test HIV Positive into the Anti-Retroviral therapy program.
- History taking, physical examination, Diagnosis Making and management of patients.
- Collection of blood samples/specimens for CD4 count, Viral Load, liver Functions tests and Creatinine Levels estimations.
- Interpretation of such results and eligibility screening for clients as such-based on WHO Staging
- Transcription of results on laboratory forms for toxicity Grading and assessing relationship to Anti-Retroviral drugs.
- Monitoring of such adverse events that may come due to anti-retro viral therapy and managing them.
- Adherence counselling to clients starting and continuing ART
- Self Quality control on the work done and correction of such discovered by the quality control nurse
Duties:
Screening, Diagnosing and treating patients, counselling in HIV and Managing HIV/AIDS Patients
Duties:
Screening, Diagnosing and treating patients, counselling in HIV and Managing HIV/AIDS Patients
The program was focussing more on Health Care management though it had a Business management component. Program was Master of Business Administration in Health Care management
This is a program that saw me work as a clinical Officer General or Physician Assistant as refered to by other countries for over 5 years with the government hospitals under the Ministry Of Health