Provide consultancy services to the insurance and healthcare vertical to set up the clinical/bill review/insurance practice.
Establish and maintain communication with clients and/or team members; understand their needs, resolve issues, and meet their expectations.
Participate in RFPs, client proposals, client meetings & sales calls as directed by the supervisor.
Produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations that would impact business outcomes.
Identify the training needs that will equip the staff with fundamental skills and knowledge for the clinical/bill review/insurance programs.
Have a thorough understanding of the various system tools and operational procedures utilized within the program and provide guidance/recommendations to the operations team on improving service delivery/outcomes.
Collaborate with stakeholders on a regular basis for creating strategies.
Conduct all defined and required process compliance and adherence to all team members, partners, and third-party providers for clinical insurance program and provide recommendations to improve the framework/rectify the identified gaps.
Qualifications
Earned a bachelor's degree in any related field.
Registered Nurse (PH & US Licensed).
At least 15 years of work experience in the same industry with 2-3yrs of Director experience.
Proven experience in the healthcare/casualty/worker's compensation domain managing processes such as Intake, Clinical Utilization Review, Nurse Reviews, Medical Provider Call Center.
Excellent working knowledge on Microsoft Office applications.
Ability to efficiently manage time and keep track of multiple schedules, meetings, and initiatives.
