全职 Manager, Guarantee Letter 工作, 薪水, Sunway Medical Centre Selangor 公司招聘中 - Ricebowl

Job Purpose

1. To lead, manage and develop Business Office (BOFF) Guarantee Letter (GL) team, ensuring smooth running of operation and integration of GL team with other teams / departments to provide good quality services.

2. To perform case review on insurance related issues and audit cases, ensuring fair assessment and outcome on hospital and doctors.

3. To supervise execution of daily BOFF activities in GL team to serve the needs of the customers and stakeholders.

Job Description

GL AND INSURANCE PROCESS

· Ensure governance on GL team daily operations and tasks are completed efficiently, courteously and professionally.

· Review discharge bills to ensure consistency with the patient’s diagnosis.

· Review doctor’s professional fees to ensure compliance with the 13th Schedule fee recommendation before submitting bill to insurance companies to process final guarantee letter.

· Review and follow up on cases with fee disputes and / or queries with insurance companies.

· Moderate and mediate a win-win solution with insurance companies when there are doctor’s professional fee disputes and / or queries.

· Support entire BOFF department in resolving medical claim issues or clinical queries if required.

INSURANCE AUDIT AND CASE REVIEW

· Conduct case review and / or investigation upon requested.

· Systematic review of clinical insurance audit and generate audit report.

· Identify and conduct case study for operation improvisation and enhancement.

· Conduct data analysis for cost estimation and case reference.

Assist the Senior Manager to lead, manage and develop effective and efficient management control systems in BOFF operations; to strengthen internal revenue management processes and increase company’s bottom line.

· Work with the department managers, assistant managers and executives to develop, review and update policies and procedures pertaining to BOFF operations from time to time.

· Cascade the required information and / or actions to BOFF team and continually provide adequate supervision and / or monitoring controls to ensure compliance with company policies and / or standard operating procedures.

· Develop business strategies to improve and / or enhance GL and BOFF operations.

Supervise direct reports and develop functional competency skills to deliver quality work output and adhere to company policies and operating standards.

· Set annual objectives, targets and measurable key performance indicators using SMART framework.

· Perform job orientation and on-the-job training for new direct reports.

· Supervise the direct reports to perform transactional activities and deliver quality customer-centric services to customers according to company policies and / or standard operating procedures.

· Assign supervisors to GL team for close supervision until they are functionally competent, able to demonstrate sufficient job knowledge and portray good interpersonal skills.

· Conduct regular briefings or updates with GL team, attend to individual feedback and provide guidance to improve work performance.

· Perform secondary level of supervisory responsibilities in managing staffing matters.

Assist the Senior Manager in leading and developing BOFF capabilities to defuse severity of service failures and enhance service recovery processes; to adopt better financial and medical-legal risks management skills.

· Perform daily and / or weekly BOFF operations rounds.

· Review management information reports from all service areas and resolve divisional problems.

· Ensure all company policy and / or standard operating procedures violations are investigated and corrective action implemented.

· Regularly review all customer feedback and incidence report and initiate appropriate remedial action timely.

Job Requirements

• Bachelor of Medicine, Bachelor of Surgery (MBBS)
• Minimum 5 years of working experience in healthcare or insurance setting.
• Good team management skills.
• Computer literate.
• Knowledge of hospital information systems and management of multiple customer segments and payment modes environment preferred.
• Able to work independently and in a team with the ability to thrive in a fast-paced and result-oriented environment.
• Effective decision-making and problem-solving skills.
• Excellent verbal and written communication skills.
• Excellent organizational and multitasking abilities.
• Able to work half-day Saturdays during the 6-month probation period.