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 & Confidentiality as per Life Quest Tech policy