وجيه Akoum

1.Policy Installation:
• Responsible for the prompt and accurate installation of new policies on i*Geme in accordance to the Guarantors requirements.
• Responsible for the prompt communication of installation to Guarantor confirming finalization of details entered on the system and that the Guarantor must now upload census data through the I*Guarantor portal and validate it.
• Responsible for the prompt communication of Policy installation to the relevant GMS
• departments(CSC, Network department, Processing & Audit)
Endorsements:
• To assist all the Guarantors in resolving issues concerning additions and deletion of adherents - and consequently the accurate upload of census data
• responsible for ensuring compliance to Adherent control measures and therefore managing exceptions
2.Renewals and Monitoring.
3.Closing.
4.Managerial Function
• Training and Development : Responsible for training Guarantor staff on the use of i*Guarantor portals to promote Guarantor autonomy, dependence through greater utilization of GMS proprietary applications
• Processes and Procedures : Responsible for managing the Production department procedure manual in a manner which ensures compliance to accepted processing standards, internal & External audit requirements and company policy

Preparation of reconciliation reports needed by the network Department and Regional Offices for reconciliation
• Attendance of reconciliation sessions with Providers for clarifying accounting problems.
• Handling reconciliation and follow up for the payment of special plans agreements with the Providers
• Calculate and send agreed upon Reconc.adjustment amount per provider per insurance company.
• Prepare Reconc.reports/Settlement reports needed for Reconcile with Guarantors & Coordinate it with GMS Accounting Dept.
• Prepare pending balance per insurance company and follow it up with the TPA Dept.Management for Collection.

Follow up on the preparation of the balance confirmation letters & Acquittal forms to be distributed to Providers in coordination with the Accounting Dept.at GMS.


• Auditing and statements for reimbursement, in and outpatient claims
• supervision of date entry staff

1. Writing progress notes about the patients.
2. Filing all the doctors reports about the patients status.
3. Giving medication.