Job description:
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Collaborate closely with clinicians to manage insured and corporate-guaranteed patient services
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Ensure alignment between clinical services and insurance or corporate agreements
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Provide medical support in the socialization and implementation of updated regulations to clinicians and administrative teams
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Handle and negotiate problematic insurance claims with payers from a medical perspective
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Identify and resolve issues that may pose risks to patient safety or hospital reputation
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Conduct data analysis and escalate key issues through regular coordination with the Head of AMA
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Prepare and review Initial Medical Reports (LMA) and Follow-Up Medical Reports (LML) for discharged patients
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Ensure completeness and accuracy of insurance documentation for outpatient and inpatient services
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Support validation of medical supporting documents, including diagnostics and procedures
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Ensure daily medical reports from EMR are completed accurately
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Assist in documentation readiness for care transitions from Outpatient Services to Pre-Operative Clinic (POC)
