HCP Relationship Officer Assistant at Life Quest Technologies Ltd

Essential Duties-

Plan Hospital Risk and case management visit to familiarize Case Managers with the patient’s condition to be able to do the relevant interventions
Carry and manage Company emergence line 24X 7. Ensure that Life Quest Tech receives the pre-auth from hospitals
Accounts reconciliation of claims settlement of all eligible medical claims within agreed service level agreements (SLA) with the network health care providers and Insurers
To ensure that Health Care Providers are informed in time of the incomplete and hold claims, to avoid unnecessary disputes and disruptions in services due to non-payment of claims
Responsible for managing relationships and monthly billing reconciliations between the accounts dept and various Insurance Companies/ Healthcare Providers to ensure that claim are settled within SLA; send claim settlement advice to the health care providers within 48 hours of receiving confirmation of transfer and sign off on monthly billing basis
Reconcile of all payments with health care providers within 60 days of receiving settlement transfer advice; health care providers are required to re-submit suspended claims requiring additional/missing information within 30 days of advice and you will be required to ensure that this is adhered to as per SLA

General Duties-

Ensure that the providers adhere to the Insurer policy cover during the member’s hospitalizations
Liaise with the network providers to ensure a seamless admission and discharge process of members
Ensure the member bill are collected from their respective hospital
Vet all bills as per policy biding the medical scheme at hand
Be able to submit reports as per SLA of respective clients
Continuous training and maintaining good relationships with HCP partners
Maintain patient data & Confidencialty as per Life Quest Tech policy