Merusha Naidoo Email and Phone Number

• To monitor the provision of healthcare services to patients registered on the Disease management (DM) programme. • To maintain thorough system files on each patient enrolled on the DRM Programme, intervene in accordance with prescribed clinical guidelines, and provide outcomes reports on all cases.• To assist in the amendment and updating of clinical guidelines and policies.• To communicate and interact directly with enrolled patients and their service providers.• To empower… Show more • To monitor the provision of healthcare services to patients registered on the Disease management (DM) programme. • To maintain thorough system files on each patient enrolled on the DRM Programme, intervene in accordance with prescribed clinical guidelines, and provide outcomes reports on all cases.• To assist in the amendment and updating of clinical guidelines and policies.• To communicate and interact directly with enrolled patients and their service providers.• To empower enrolled patients to take responsibility for their health through education which is in line with the company’s vision and mission.• To assist in the drafting and distributing of information to enrolled patients and service providers.• To investigate any deviant practices and communicate with the relevant "Network ServicesProvider teams" either telephonically or in writing. • To assist in the design of the technological and operational components of the DRM Programme database/program.• To liase with the appropriate medical advisor regarding the management of enrolees and respective benefits.• To utilise the Disease Management Benefit in accordance with the DM Mandate/s Show less

KNOWLEDGE OF CPT; BHF AND ICD CODINGKNOWLEDGE OF THE MEDIAL INDUSTRYKNOWLEDGE AND APPLICATION OF SCHEME RULES, EXCLUSIONS AND WAITING PERIODSABILITY TO EXTRACT DATA FROM VARIOUS SOURCES E.G EMAILS, FAXES E.T.CAUTHORIZING OF HOSPITAL ADMISSION BOTH MEDICAL AND SURGICALUNDERSTANDING OF MEDICAL TERMINOLOGYPROCESSING OF ACCOUNTS ACCORDING TO SCHEME RATES AND RULESENSURING CORRECT SUBMISSION OF CPT/BHF IN ACCORDANCE TO ICDALLOCATING FUNDS FOR PROCEDURES ACCORDING TO… Show more KNOWLEDGE OF CPT; BHF AND ICD CODINGKNOWLEDGE OF THE MEDIAL INDUSTRYKNOWLEDGE AND APPLICATION OF SCHEME RULES, EXCLUSIONS AND WAITING PERIODSABILITY TO EXTRACT DATA FROM VARIOUS SOURCES E.G EMAILS, FAXES E.T.CAUTHORIZING OF HOSPITAL ADMISSION BOTH MEDICAL AND SURGICALUNDERSTANDING OF MEDICAL TERMINOLOGYPROCESSING OF ACCOUNTS ACCORDING TO SCHEME RATES AND RULESENSURING CORRECT SUBMISSION OF CPT/BHF IN ACCORDANCE TO ICDALLOCATING FUNDS FOR PROCEDURES ACCORDING TO THE SAMA GUIDELINES AND PROTOCOLS DATA CAPTURING ATTEND TO CALLS IN AN INBOUND CALL CENTRE AND OUT BOUND INTERVENTIONS TO FOLLOW UP PROVIDING PRE-AUTHORISATION INFORMATION TO MEMBERS,BROKERS,HOSPITALS AND ALL CLIENTS ,RE-ADMISSIONS,TREATMENT AND BENEFITS Show less

Pre-authorisations and Case Management for hospital admissions Liaising with UK clients,Doctors,Health care Professionals… Show more Pre-authorisations and Case Management for hospital admissions Liaising with UK clients,Doctors,Health care Professionals Knowledge of Private medical Insurance for the United Kingdom Show less