Utilization Management
Authorization Auto Approval
- Built application for auto approval of authorization based on various UM guidelines (including LCDs, NCDs, various health plan medical necessity guidelines)
- Expertise in fax form and web portal development to facilitate auto approvals
Authorization Auto Approval
- Built application for auto approval of authorization based on various UM guidelines (including LCDs, NCDs, various health plan medical necessity guidelines)
- Expertise in fax form and web portal development to facilitate auto approvals
Authorizations Workflow System
- Developed workflow systems for authorization processing
- Capable of handling large volume(>5,000 per day) of authorization reviews manually or automatically along with document management
- Flexibility to define and alter workflow and validation rules based on company or line of business or service type or other factors
- Allows for easy reporting of all events (auto captured) related to authorization processing and ensuring timeliness
Authorizations Workflow System
- Developed workflow systems for authorization processing
- Capable of handling large volume(>5,000 per day) of authorization reviews manually or automatically along with document management
- Flexibility to define and alter workflow and validation rules based on company or line of business or service type or other factors
- Allows for easy reporting of all events (auto captured) related to authorization processing and ensuring timeliness
Authorizations Workflow System
- Developed workflow systems for authorization processing
- Capable of handling large volume(>5,000 per day) of authorization reviews manually or automatically along with document management
- Flexibility to define and alter workflow and validation rules based on company or line of business or service type or other factors
- Allows for easy reporting of all events (auto captured) related to authorization processing and ensuring timeliness
Super Authorizations
- Designed scripts to group multiple authorization created in one episode of case to ensure smooth claims matching in various situation
- Designed ways to match more than one claim based on same authorization while avoiding duplicate payment
Post Decision Automation
Adept in handling peer to peers, reconsiderations, appeals and any other post decision activity from a systems, compliance and process point of view
Post Decision Automation
Adept in handling peer to peers, reconsiderations, appeals and any other post decision activity from a systems, compliance and process point of view