Milimo Sikoobwe

• 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