Amala Pious

• Contact insurance companies and follow up on any denied claims
• To follow authorization process of claims for the patients admitted to hospital and all other contracted insurance companies if the insurance officer has exhausted all attempts
• To maintain the confidentiality of patient information
• To ensure that all admitted patients with valid insurance policy through daily admission list provided from medical record are processed in the authorization office to avoid any denials and late notification
• To communicate efficiently with medical members and ward clerks to collect the medical data required to authorize patient’s stay
• Also, close collaboration with the medical coders is required
• Notification of rejected services should be given to the responsible assigned center coordinator.

ADMIN ASSISTANT

• Serve as the eyes and ears of the office, providing information, answering questions, and responding to requests
• Ensure optimal use of office equipment, supplies, and inventories through preventive maintenance
• Maintain workflow by analyzing and refining standard operating procedures, such as scheduling, communications, and office layout
• Coordinate internal and external resources to expedite workflow
• Oversee and achieve organizational goals while upholding best practices
• Provide administrative support to senior leaders, including email correspondence and generation and distribution of memos, letters, spreadsheets and forms.
• Plan, organize, and schedule company meetings in the office, off-site, and via videoconference
• Coordinate domestic and international travel arrangements for employees
• Maintain filing system, contact database, employee list, and inventory
• Order and oversee office supplies and food deliveries for group meetings.
• Assisted in onboarding new employees, providing training materials, and coordinating orientation schedules to ensure a smooth integration into the team.
• Organized office events such as holiday parties or team-building activities, promoting a positive company culture and boosting employee morale.
• Maintain accurate records and update patient information in the hospital software system
• Assist in resolving any customer service issues and complaints
• Ensured the preparation and billing of complex clients
• Invoices in compliance with firm policy
• Billing
• Filling claim form
• Reconciliation of the claims and maintain accurate records.

• Key Outputs Prospective Insurance companies identified, agreements reviewed, the selection made, and contracts awarded
• Insurance policies are implemented after the agreement is signed
• Follow up and negotiations with Insurance Companies where needed to ensure approval of problematic cases
• Exhausted benefits identified in close liaison with resubmission team to ensure maximum recovery from Insurance companies
• Insurance protocols complied with at all times
• Disallowance reconciliation and mutual settlement coordinated with Insurance Companies
• Insurance disallowance write-offs coordinated with the Accounts Receivables department after proper reconciliation
• Disallowance reasons evaluated, improvement areas identified, and changes implemented
• Submission of Insurance department statistics monthly
• Work distribution within insurance team/coaching of insurance team members
• Management of regional operational insurance programs (property-business interruption, third- party liability) Including service agreements with brokers
• Preparation of detailed considered budgets for assets in operation and projects under development Establish, communicate, and manage goals and expectations for the department and individual performance
• Plan and facilitate effective team meetings to share important customer or product knowledge resulting in improved communication and proactive resolution to customer inquiries
• Regularly review outstanding claims and liaise with the Management/Finance Department to ensure the adequacy of claim reserves
• Control and monitor the appointment of Loss Adjusters and carry out minor surveys
• Prepare all statistics required by Management including Claim cost, Average Claim Ratio
• Achieve monthly team targets in terms of claims processed
• Communicate with other department managers pertaining to issues related to claims processing and vice versa.
• Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
• Communicated verification and authorization status updates with department to facilitate decision-making for patient admissions and insurance coverage.

• Document collection at the time of Patient Admission and counselling
• Obtain and process prior authorizations through established protocols, policies and procedures
• Effectively communicate via phone, email, or in writing with physicians, nursing homes, and pharmacies regarding approvals and denials
• Preparing and sending soft copy of submitted claims statement to some insurance companies
• Answer questions, requests and resolve issues from providers, pharmacists and staff
• Address various issues related to prescription drug benefits, prescription formularies, prescription claims processing and prior authorizations
• Resolve routine nursing home and pharmacy concerns and questions from various sources, and, where appropriate, suggest a plan of action to resolve coverage issues
• Provide administrative support to the pharmacy team and management
• Gather and compile data for weekly and monthly reports pertaining to claims approvals, denials, and pending claims
• Reconciliation of the claims.
• Checked documentation for accuracy and validity on updated systems.
• Contributed positively to team morale by consistently demonstrating a collaborative attitude and willingness to support colleagues.