Medical Manager

• Manages the operations of Unicare network
• Establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing
•  Involved with the design and operations of database systems used to manage provider data and produce reports and analysis
• Handle relationships with clients regarding reimbursement claims by asking for additional information whenever required, by explaining the details of the settlements (i.e. application of the deductible and coverage, justify rejections and uncovered expense)
• Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation
• Manage discharge plans upon completion of treatment
• Maintain the patient's comprehensive clinical record through detailed documentation
• Performing technical audit on medical claims
• Explain the rejection reasons of any rejected cases and facilitate reconciliation process

job requirements

7 to 10 years

Not Specified