保险审核专员(013684)

工作职责

• Contacts insurance companies to verify patient's insurance coverage and patient's responsibility with relative department
联系保险公司以确认患者的保险福利及个人与其相关科室的保险承担责任

• Respond to patient inquiries and well interpretation of patient's responsibility based on insurance benefit feedback (online/telephone)
有效回应患者的疑问并充分向患者解释保险公司在线查询/电话反馈的福利涵盖情况

• Provide assist to doctors, nurses, cashiers, pharmacists and other staff in different department via phone or email when needed to communicate effectively with patients
通过电话或邮件的方式,协助患者和医生,护士,收银,药房和其他不同部门的工作人员进行沟通

• Determines contract price and insurance benefit eligibility for pre-certification, offer prior authorization of inpatient and outpatient services
确定套餐价格和保险福利的预授权认证,为门诊及住院患者提供事先预授权服务

• Works with patients in securing prepayment sources or financial agreements prior to providing service
在提供服务之前,与患者合作,确保预付资金来源或财务协议

• Conducts financial screening for all patients (MRI/CT/Gastroscopy& Colonoscopy, Observation, Surgery, Admission, High value items) and asks for the pre-authorization/payment guarantee in advance to expensive examinations for all out and in-patients
对所有患者进行财务筛查(MRI/CT/胃肠镜、留观、手术、住院、高价项目), 并对所有门诊/住院病人在进行昂贵的检查提前进行预授权筛查/保险担保函授权确认的保证

• Assists patient on insurance coverage related matters
协助患者办理保险相关事宜

• Responds to and follows through on patient and insurance related inquiries
回应并跟进患者和保险相关的咨询

• Strictest confidentiality of patient information
对患者信息严格保密

• Estimate and produce various surgical quotations according to the requirements of doctors and customers
根据医生和客户病情的要求,预估并制作各种手术报价

• Perform primary patient access to ensure patient-satisfaction rate increase in the clinic. Collect patient feedback. Report to manager regularly.
提高患者满意度,收集患者反馈,分析患者需求,向上级定期报告

• Assist Supervisor/Manager with any new initiatives or special projects
协助主管/经理完成新的任务或额外项目

• Provide professional guidance to new colleagues, conduct internal training, share insurance audit skills, communication strategies with insurance companies, and ways to handle complex cases.
为新入职同事提供专业指导,开展内部培训,分享保险审核技巧、与保险公司沟通策略以及处理复杂案例的方法。

• Analyze existing work processes, identify inefficiencies, propose and implement optimization recommendations, and improve the overall efficiency and quality of insurance audit and related transaction processing.
分析现有工作流程,识别低效环节,提出并实施优化建议,提升保险审核及相关事务处理的整体效率和质量。

• Keep track of the latest policies, regulations and market dynamics of the insurance industry, timely adjust the hospital insurance review strategy, and ensure that the hospital protects the interests of patients and hospitals to the greatest extent under the premise of legal compliance.
跟踪保险行业的最新政策法规和市场动态,及时调整医院保险审核策略,确保医院在合法合规的前提下,最大程度保障患者权益和医院利益。

任职要求
Qualifications:

• Associate college degree or above preferred;

• CET-6/TEM4 and above preferred

• Working experience in service industry /cashiering/ customer service preferred;

• Previous working experience in international hospital / clinic or hotel/Insurance preferred.

• Experience in relevant department at least 1 year

Skills:

• Excellent language skills in Chinese and English, verbal and written

• Familiar with Microsoft Office tools

• Good customer service and problem-solving skills

• Professional manner and etiquette

• Communicating skill in interacting with patients and colleagues

• Can work shifts, work well under pressure and remain calm in challenging situations and be able to work on multiple tasks simultaneously

• With the ability of data analysis, can provide data support for hospital decision-making through the analysis of insurance business data

• Excellent negotiation ability, able to negotiate favorable terms in cooperation with insurance companies.

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