Job Summary : This position is is crucial in ensuring that members receive quality healthcare services while mitigating financial burdens. By effectively managing costs, advocating for members, and promoting transparency in healthcare processes, you will contribute to improving member outcomes and satisfaction. This position offers a unique opportunity to make a meaningful difference in the lives of individuals and communities by optimizing healthcare accessibility and affordability. To work with concept Health Care Partner.
be the contact point when member requires the hospitalization, register the case and coordinate with the relevant teams i.e. pre-arrangement, pre-authorization, claims, medical team, provider relation team as well as the external party i.e. selected provider.
- Coordinate with pre-arrangement team for coverage checking and confirmation.
- Coordinate with the provider ensuring the appointment is made and necessary information is obtained and shared to member i.e. if selected medical item is not covered.
- Provide accurate and relevant information to member regarding medical procedures, treatment options, and healthcare resources.
- Advise/recommend alternative medical options i.e. conservative treatment, Second Medical Opinion, etc. Assist to facilitat appointments.
- Coordinate with the related teams to assist member in maximizing the benefits from all the available funds.
- Follow up with member and the provider ensuring the smooth admission on arrival.
- Contact the member/relative to ensuing that member is fully informed of the necessary information including the diagnosis and treatment plan.
- Maintain & updating patient cost and inform member/relative of the non-payment items, if any, and includes the potential shortfall amount.
- To monitor admission case for follow up and update customer along with whole procedure until discharge.
- Work closely with the pre-authorization team and concurrent review team on the discharge plan and the necessary info to be communicated with the member / his/her corporate.
- Keep accurate records of patient interactions, insurance communications, and cost negotiations to track progress and ensure compliance with regulatory requirements.
General Management
- Support medical projects
- Customer focus e.g. Handle complaint from customer related to health concierge service
- Communicate network service to customer
Qualifications :
- Bachelor's Degree in Nursing Science, or related filed. Additional certifications in medical billing, coding, or healthcare management are desirable.
- Preferably 3-5 years experiences in service industry or health insurance business or claim unit to be advantage.
- Familiarity with cost containment strategies and negotiation techniques is highly beneficial.
Allianz Ayudhya
