Job Description
- Responsible for the case control manner in the health facility.
- Conduct ward rounds and make certain the correct whole collection of health center records from patient files and liaisons with nursing group of workers and attending clinicians.
- Update correct medical information to justify, period of live (LOS) and level of care (LOC) to medical budget the assigned managed care company.
- Update and provide the important data to funders regarding HV (high fee) gadgets, limited advantages and protocols as defined via controlled care agencies.
- Communicate funder requirements / responses to attending clinicians and patients in which essential, and make certain compliance with enterprise standards.
- Ensure effective control of actual time and manual messaging, along with request, responses, rejections and submissions.
- Ensure the correct submission of debts to funders.
- Understand and ensure adherence to patient’s offerings guidelines and procedures.
- Ensure correct and complete coding of patient debts.
- Ensure the appropriate utility and accurate interpretation of funder contracts.
- Ensure the proper software and accurate interpretation of funder FFS claims
- Action and close off brief fee queries related to assigned obligations.
- Adherence to affected person services escalation tactics.
- Drive adherence to customer service standards.
- Foster and preserve healthy relationships with inner stakeholders. E. G. Nursing.
- Ensures accurate software and interpretation of specialized wards criteria.
Company Profile:
Salary: Not disclosed
Industry: Insurance and Medical
Functional Area:
Role Category: Relationship Manager
Employment Type: Full time
Keyskills
