Freelancer, Case Management
Freelancing
Total years of experience :20 years, 6 Months
Case Management, Clinical Auditing
Business Operations Dept.
Out-Patient Department
Eligibility, Patient Access Services (EPAS)
Utilization Review
Case Management Sprv.
- Manage daily operations related to outpatient scheduling, pre-registration, admission and pre-authorization.
- Coordinate and track the work flow necessary to register and schedule patients and properly address all patient
inquiries.
- Supervise a professional medical insurance team in daily routine operations: insurance coverage, approvals,
costing, eligibility, pre-authorization and financial clearance.
- Maintains processes which impact admission, and other patient access function.
- Revenue Cycle Management, leading the application of billing, submissions and follow up of claims and
payment reception.
- Claims management, coding -ICD 9/10 systems.
- Reviewing, auditing medical claims, reconciliation and assuring excellent customer service.
- Assist in implementation of medical claims processes, reconciliations protocols and to communicate & clarify
to clients, medical networks & intermediaries.
- Improve financial information flow to the members of the hospital multidisciplinary team.
- Eligibility check point for eligible and referral cases as agreed contracts and price lists.
- Cost estimation process as applicable with insurance limits and exclusions.
- Insurance policies reviewing, summarizing.
- Development and application of healthcare plans and evaluation of effectiveness and appropriateness of
treatment provided.
- Assist in the review and modeling of procedures to improve efficiency.
- Establishes processes and protocols to enhance projects management and achievements.
- Recommendation of alternative treatment protocols.
- Monitor the treatment plan and evaluating policies and procedures compliance attitudes.
- Assessment of projects timeframe, and developing new capacities.
- Utilizing the treatment process & critical thinking skills with coordination of care for assigned patients.
- Educate patient, family and health care team members regarding appropriated level of care.
- Serves as an educator as related to the Care Management process to patient/ families and other health care
team members.
- Ensure proper documentation and validation.
- Maintain and advancement of patient confidentiality and safety standards.
- Ensuring compliance with applicable hospital policies and procedures, International standards, Governmental
laws and Third Party reimbursement Systems requirements.
- Performing any other related duties as required supporting the activities and overall strategic directions in
order to ensure the profitability of the company.
A Registered nurse responsible through out:
- Administrative activities.
- Team Leader.
- Educational program coordinator.
Professional Lecturer for newly hired staff.
- Assisting University instructors evaluating training practitioners.
- Participating in quality control programs.
- Professional Nursing skills in a specialized In-patient and Out-Patient department of Orthopedic, Ophthalmology and ENT.
A Registered nurse responsible through out professional Nursing skills in a general medical and surgical department.
Healthcare Financial Management Association (HFMA) Certified Revenue Cycle Rep. (CRCR)
Chartered Insurance Institute ( CII ) Cert-CII Private Medical Insurance Practice.
Qualified courses in Business Administration, Financial Management, Business Development, Risk Management and Control System.
Qualified courses in general Nursing. GPD: 2.53