Professional II, Service Delivery Healthcare
Conduent, Inc
Cebu City, Central Visayas,Philippines
4d ago

Description

Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience.

We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.

We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.

Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning -

Conduent manages and modernizes these interactions to create value for both our clients and their constituents. .

Purpose :

  • Responsible for providing professional and analytical support to medical services programs, including implementation, operation and contract compliance (e.
  • g., Medicare); Utilization Review; Condition Management; Health Care Coordination; Case Management; Insurance Claim Administration;
  • Pharmacy Services; Medical Services; Collection Services; Negotiates liability settlement of medical claims with third parties or healthcare providers;
  • seeks reimbursement from healthcare providers and / or ensures payment of claims by appropriate insurance carrier.

    Scope : General :

    General :

  • Uses best practices and knowledge of internal or external business issues to improve products or services
  • Acts as a resource for colleagues with less experience
  • Requires in-depth knowledge and experience
  • Decisions guided by policies, procedures and business plan
  • Generally domestic scope / accountability
  • Primary Responsibilities :

  • Receives and interprets physician’s prescriptions for medications
  • Dispenses medications and other pharmaceuticals according to prescriptions
  • Counsels customers in the use of complex / health hazardous medications
  • Interacts with customers to ascertain nature of illness / affliction and recommends medication / use within closely prescribed guidelines, consistent with state, federal and regulatory guidelines
  • Additionally, may provide the following services :
  • Reviews patient prescription history and identifies possible safety or conflict issues. Communicates findings to treating physician.
  • Provides professional and analytical support focusing on the analysis, program development and evaluation of applicable medical services offerings (including medical, dental and pharmaceutical).
  • Analyzes existing medical, dental and pharmacy plans to ensure performance measures are being met; makes recommendations on methods for improvement.
  • Develops applicable utilization reports focusing on pharmaceutical, dental and medical plan usage; provides analyses and recommendations based on findings.
  • Provides professional / analytical support to applicable medical services programs including implementation, operation and contract compliance (e.
  • g. Medicare / Medicaid program).

  • Ensures company compliance with federal and state laws
  • All other duties as assigned
  • Apply
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