Daman - National Health Insurance Company
• Deliver high quality customer service and respect medical & work ethics at all times• Ensure that I&S business decisions & processes are documented in a professional way, adhering to Daman communication requirements
• Interact with medical units to capture the needs for new or changes guidelines and training & evaluation
• Carry out ongoing medium to complex I&S activities:
o Develop medical guidelines (and accompanying rules) in line with the end-to-end process view of the company (note: for medium to complex cases)
o Deliver training to the medical units as per agreed training and evaluation program
o Supports the rule implementation processes, e.g. rule engine
• Assist in documenting the medical decision process, evaluating the completeness of guidelines and prioritizing/sequencing the development of new guidelines. Evaluate & report of the effect of implemented guidelines and rules/procedures
• Identify and support improvement opportunities for the I&S unit
• Provide support to strategic medical initiatives under supervision of the Manager
Skills
Experience Requirements:• Certification from the American Health Information Management Association or
• Certification from the American Academy of Professional Coders
•Minimum of three years experience in the healthcare insurance industry in:
o Medical coding (good knowledge with CPT4 and ICD9 CM and two of the following coding systems: UCLS, MOH, HCPCS or SRVC, and/or DRG is a prerequisite
o Guidelines development and implementation
o Claims/prior authorization automation (edit ruling, auto-computation and fully automated processing)
• Minimum of 2 years experience in project management (preferred)
• Minimum of 2 years supervisory experience (preferred)
Education
Paramedical degreeApply Now
