Medical Claims Examiner or Claims Officer Training and Development Needs

Prep ared By Solomon Sawerh PetteyOrganisation Osu Klottey NHIS view Osu, Accra Ghana Medical accepts quizzer orClaims federal agencyr training & organic evolution trigger Significant achievements have been made at arresting potential asseverate think challenges which threatened NHIS sustainability, but the claims still watch coming in fast with change magnitude work load. The offices of applied science and claim officers to impressively manage claims also continue to enhance with meaningful results.This document therefore aims to use a scientific management admittance to intend the training and development call for of claims officers, which can further enhance the effective and efficient management of claims. Case in Point Claims officers need to have genuine companionship, skills and abilities to examine checkup claims effectively. The psyche is what is the on-line(prenominal) content gap of knowledge, skills and abilities? The work of medical claim exam ination and approval are critical and complex and this lends support to the question above.The research aims to determine the training and development needs of claims officers by examining levels of education, professional downplay and prior knowledge of claims vetting and ways to determine the impact of training. Focus get out be on the claim officers perspective of needs, outgo approach to close capacity gaps, and break out enhancement of NHIA activities towards the improving upon the performance of claim officers.About 70% of NHIS claims have been projected to be processed electronically, but leveraging technology in terms of claims management will not adequately address the capacity deficit, unless the manpower is well equipped to apply meaningfully towards the rrealization of the companys strategic goals. Approach Benchmarks Challenge of expenditure conventional methods versus JUST-IN-TIME training and development for practical knowledge Continuum of learning/E-learning T ailored Programs / wellness policy Training Institutions / International AssociationsSAMPLE CONTENT preparation AND DEVELOPMENT ACTIVITY PROGRAM (P) radical outline of programs which can be designed to prepare participants to meet the challenges of health look at revenue cycle management including insurance reimbursement and accounts receivable management, with strong emphasis on clinical knowledge needed to go bad the content of medical records for optimal reimbursement P 1, Medical Aspects of Claims describes the anatomy and physiology of the human body, as well as disorders and treatment of the discordant body systems.P 2, Basic Pharmacology entry to the basic study of drugs, therapeutic uses, window pane and actions. P 3, Health Insurance virtue provide an down the stairsstanding of the insurance policy as a legal take up aspects of statutory integrity, case law, and common law as they pertain to claim administration. P 4, Claim Administration administration of claims under health insurance contracts (both individual and group), including investigation and cost control techniques.P 5, Management of Claim Operations application of management supposition to the operations of claim departments, including the management functions of planning, controlling, organizing and leading. P 6, Foundations of Insurance Marketing and Customer servicing marketing principles and functions, customer service concepts and strategies as integral aspects of health insurance Foundations of honesty Details/courses Anatomy and Physiology and Introduction to humanity Disease Presentation Techniques, Advanced Composition, kind in Society Foundations of Health Professions apply Information Technology Medical lyric and Introduction to Health conducters Major account statement Foundations Administrative Procedures or Medical Office Applications Health Record Content Health Care Management Foundations Procedural and diagnostic Coding Introduct ion to Health Care Reimbursement Systems and Reimbursement Applications Claims Management Practicum Health Care virtue and Ethics