Case Manager/Pre Authorization In-charge
Neuron LLC
Total des années d'expérience :16 years, 3 Mois
Conducting weekly and monthly meeting
Training and monitoring Team’s performancy
Monitoring and training on cost containment
Doing case management for hight cost and complicated cases
- Doing case management in high cost and complicated cases to provide better quality, patient care and malpractice
Handling high cost cases & assessing medically for pre authorization
Handling/leading the team
Handling & solving client's complaints
Assessing claims & Auditing
- Handling incoming client/provider emails for ongoing/escalated IP cases
- Authorizing medical treatment & associated diagnostic testing on assigned
claims as allowed by various insurance policies.
- Doing case managements.
- Auditing paid claims and fraudulence with providers.
- Handling provider calls and providing them the quality of assistance following
the company guidelines & protocols
- Reviewing case records & reports, collecting and analyzing data, evaluating
client’s medical status and defines needs & problems in order to provide case
management services
- Handling incoming client/provider emails for ongoing/escalated IP cases
- Authorizing medical treatment & associated diagnostic testing on assigned
claims as allowed by various insurance policies.
- Doing case managements.
- Auditing paid claims and fraudulences with providers.
Jayasetha Mediclinic is a modern equipped nursing home and channeling center, which is located around 20 km away from the capital of Sri Lanka.
- Treating patients symptomatically (OPD & In Patients)
- Emergency care treatment
- Taking care of wound treatments (Diabetic wound, Toilet wounds and etc.)
- Catheterization & Suturing
- Immunization & Family Planning
- Attending home visits
Ceylon Tobacco Company PLC (British American Tobacco)
- Handling and Managing critical care cases
- Treating in house patients symptomatically
- Counseling and advising
- Annual Health check ups
Kellogg Brown & Root (KBR), is an American engineering, construction and private military contracting company, formerly a subsidiary of Halliburton, headquartered in Huston.
KBR has won many contracts with U.S. Military, and one of it was Operation Iraqi Freedom.
MAY 2010 TO AUGUST 2011
Site Doctor (US Air Base - Taji)
- Treating Casualties and airlifting them to Victory Base (Iraq) Military Hospital
- Symptomatically treatment for the KBR employees, DFAC employees
- Conducting daily Fit For Duty for DFAC employees
- Vaccinating and medical updates
- Annual Health check
Cumberland Insurance & Reinsurance Company, which is located in Al Khobar -
Kingdom of Saudi Arabia
FEBRUARY 2008 TO APRIL 2010
Medical Officer - Claims (Reporting to Medical Director)
- Claims Processing
- Pre Approval and Auditing
- Coordinating with network providers and TPA's in relation to network details & other services
- Processing and reconciliation on direct billing and reimbursement