Case Manager(Medical)

Case Manager(Medical)

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

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