I strive to deliver good customer service and to ensure our customers feel valued and appreciated in a time when they expect the best service in return for their paid premium. Since mid-year review I have made the effort of proactively getting back into the claims for follow up with customers, attorneys and medical providers; I believe my year end numbers are a reflection of my daily work and
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• Ensure service members’ records were filed properly and maintained in the individual record. • Procure service member records in-order to be mailed out to other claim offices, having major effects on individuals. • Ensure all regulatory requirements pertaining to individual privacy were adhered to. • Research and obtain all necessary paperwork and relevant information regarding cases and issues pertaining to individual records. • Identify records, inconsistencies and initiated actions to correct the problems.
To the Board of Directors of Southside HMO: As the Chief Executive Officer (CEO) of Southside Health Maintenance Organization (HMO), I am providing a detailed report of my strategies and recommendations to make sure that the quality and management processes of our healthcare organization are being provided to all members. There has been a complaint filed against the Southside HMO that patients that are enrolled in the Health Plan are not receiving quality healthcare delivery. Southside HMO provides healthcare services for over 495,000 members located in the eastern region of the United States. These strategies and recommendations are for resolving any complaints of denial of healthcare services for referrals to see a specialist by primary
On Oct 3, 2016, at 2332 hours, console operator dispatch all available officers to the yellow zone that a African American female that have elope from 5 Medical Park, Yellow Zone, room 17. My first responder to Pod 9 was Security Officer Kinard and Hinton. They found the female patient standing in the ambulance bay standing their doing nothing. The two Officers escorted her back to room 17 before I, Sgt Perdue arrived.
CMO continues to meet weekly and as needed with division leaders to identify issues and factors that need to be addressed in order to ensure the appropriate operational approaches that should impact clinician as well as client satisfaction and therefore better outcomes. 1. Ongoing in-services for our prescriber staff in the use of our Electronic Health Records (EHR) continue to translate into improvement of the required content in order to justify appropriate billing codings to enhance our collection rates. Chief Medical Officer has personally being reviewing a random number of cases per provider and meeting with them individually to provide feedback and improve their performance. This should also impact obtaining the documentation needed for appropriate coding and improved collections.
Despite an August 2015 WEDI Survey that said one in four doctor practices weren’t ready for the October 1 transition to ICD-10, insurers are happy with what they are seeing so far. Both UnitedHealth and Humana are reporting on smooth rollouts. Humana has reported that only 0.03 % of all calls from providers were regarding benefits, claim status, spanning date of service, and authorization. United similarly reported that call volumes from providers have been “normal” with only a “slight uptick” in claim
The CQC uses and monitors services continuously, it is also the entity responsible for gathering and analysing information, then publish their findings to give consumers clear information when making choices and to help services improve. The kind of information they use is inclusive of: information collected directly from care providers, information about people’s experiences and vies from their families and carers and lastly data used to plan inspection
Learning the codes of practice ensures that I promote and uphold the privacy, dignity and rights of the clients I care for and that I strive to improve the quality of healthcare, care and support through continuing professional development. I achieve this within my job role by ensuring that the service users and their families are informed and included in all aspects of their care
Quality and measurement theories that abandon the highest levels of appropriateness, will accomplish the healthcare industry evaluates the accountability costs and impacts. Having an understanding of the scrutiny of service, responsibilities, customer satisfaction, effective service and performance, and outcome assessments are all requirements of accountability, which are part of the continuum for accountability (Ledlow & Coppola,
They make sure this is achieved through offering the highest quality of services. One of the
Hayes and her colleagues were always quick to consult consumers for their insights and opinions. For example, prior to Boardwalk Clinic’s grand opening, the physicians test marketed the operation by offering a group of 12 Chelsea residents free examinations in exchange for their insights and opinions regarding the clinic’s décor and accommodations, processes and procedures, care delivery, and customer service (Fortenberry 2011). They also initiated an ongoing patient satisfaction surveys and acted on the findings, ensuring ongoing attention to patient wants and needs. These efforts led the physicians to believe that patient retention would be