Medical Manager at Sunu Group

QUALIFICATION:

• MBBS, MPH

EXPERIENCE:

• 8 10 years’ relevant work experience.

MAJOR DUTIES/RESPONSIBILITIES

• Ensure best practices are adhered to in quality of care administered to enrolees following standard treatment guidelines and protocols. 
• Coordinate Claims processors work process. 
• Authorize/vet NHIA and PHIS claims according to agreed tariff, Health guidelines and protocols.
• Engage in provider forum. 
• Conduct providers’ satisfaction survey biannually.
• Provide quality assurance support in re-accreditation/accreditation of providers
• Visit of enrollee with serious medical condition to confirm quality of care.
• Provide support for the development of benefit packages 
• Track and manage fraudulent codes.
• Participate in medical outreach, wellness and health seminar for clients.
• Collaborate with other departments.
• Medical verification of bills to ensure adequate treatment.
• Monitor mode and manner of medical care rendered by providers. 
• Participate in reconciliation of payments with providers 
• Train and develop in-house medical operation capacities with current best practice.
• Checking enrollee status and approval.

REQUIRED SKILLS

• Proficient in Microsoft suit
• Knowledge of Health Insurance Industry & Regulatory practices.
• Excellent communication skills
• Problem solving skills
• Strong ethical values
• Presentation Skills
• Emotional Intelligence