Medical Claims Examiner or Claims Officer Training and Development Needs

Prep atomic number 18d By Solomon Sawerh PetteyOrganisation Osu Klottey NHIS Location Osu, Accra Ghana Medical Claims Examiner orClaims Officer training & development inlet Significant achievements have been made at arresting potential declare related challenges which threatened NHIS sustainability, but the claims still continue coming in dissolute with increased work load. The uses of technology and claim officers to effectively manage claims also continue to advance with meaningful results.This document therefore aims to use a scientific management approach to determine the training and development needs of claims officers, which can further enhance the effective and efficient management of claims. Case in height Claims officers need to have certain knowledge, skills and abilities to examine medical claims effectively. The question is what is the current capacity gap of knowledge, skills and abilities? The work of medical claim examination and approval are critical and comp lex 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 background and prior knowledge of claims vetting and shipway to determine the impact of training. Focus will be on the claim officers perspective of needs, best approach to close capacity gaps, and better enhancement of NHIA activities towards the astir(p) 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 non adequately address the capacity deficit, unless the manpower is intimately equipped to contribute meaningfully towards the rrealization of the companys strategic goals. Approach Benchmarks Challenge of expenditure handed-down methods versus JUST-IN-TIME training and development for practical knowledge Continuum of learning/E-learning Tailored Programs / Health Insurance Training Institutions / International AssociationsSAMPLE CONTENT TRAINING AND DEVELOPMENT ACTIVITY broadcast (P) Basic outline of programs which can be designed to prepare participants to meet the challenges of health care revenue cycle management including insurance reimbursement and accounts receivable management, with toilsome emphasis on clinical knowledge needed to analyze 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 various body systems.P 2, Basic Pharmacology introduction to the basic study of drugs, therapeutic uses, dosage and actions. P 3, Health Insurance right provide an understanding of the insurance policy as a legal contract aspects of statutory law, 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 grou p), including investigation and cost control techniques.P 5, Management of Claim Operations activity of management theory to the operations of claim departments, including the management functions of planning, controlling, organizing and leading. P 6, Foundations of Insurance Marketing and Customer Service marketing principles and functions, customer service concepts and strategies as total aspects of health insurance Foundations of Excellence Details/courses Anatomy and Physiology and Introduction to Human Disease Presentation Techniques, Advanced Composition, Diversity in Society Foundations of Health Professions apply Information Technology Medical Terminology and Introduction to Health Careers Major Accounting Foundations Administrative Procedures or Medical Office Applications Health Record mental object Health Care Management Foundations Procedural and Diagnostic Coding Introduction to Health Care Reimbursement Systems and Reimbursement Applications Clai ms Management Practicum Health Care Law and Ethics