health care provider records quality orientation and attention to These tasks will require the the importance of verifying eligibility criteria for health and contracts , process health individual to take responsibility of detail. eligibility for health insurance insurance schemes and insurance claims & his/her own work and learning and schemes associated level of benefits coordinate health insurance full responsibility other’s work & The core & generic job skills to methods and tools to verify basic legal and regulatory claims on behalf of health learning. collecting and organising eligibility of applicants and the requirements governing care providers. information, communication that an associated level of benefits contracts Individual at this job does not work individual should have, will help procedures for obtaining how to prepare healthcare under supervision, as needed at Level him/her understand & manage signed contracts from provider contracts 3 & is responsible for his/her own assigned works in the context of the healthcare providers how to set up, configure and learning. He/she is fully responsible social environment of the customer. what to do when contracts update healthcare provider for other’s work & learning (unlike have not been returned records not/partially as in level 4/5). different types of claims and procedures and techniques used He/she is also sometimes fully how to deal with these for confirming record/contract responsible for the output of the methods and tools to verify details with providers and group. Therefore, this QP is justified eligibility of claims implications for organization if to be pegged at Level 7. how to determine the amount this is not done of claims using explanation of benefits (EoB) documentation Summary of other evidence (if used): Validated by Industry council through various workshops and through training provider stake holders
health care provider records and contracts , process health insurance claims & coordinate health insurance claims on behalf of health care providers. the importance of verifying eligibility for health insurance schemes methods and tools to verify eligibility of applicants and the associated level of benefits procedures for obtaining signed contracts from healthcare providers what to do when contracts have not been returned different types of claims and how to deal with these methods and tools to verify eligibility of claims how to determine the amount of claims using explanation of benefits (EoB) documentation eligibility criteria for health insurance schemes and associated level of benefits basic legal and regulatory requirements governing contracts how to prepare healthcare provider contracts how to set up, configure and update healthcare provider records procedures and techniques used for confirming record/contract details with providers and implications for organization if this is not done quality orientation and attention to detail. The core & generic job skills to collecting and organising information, communication that an individual should have, will help him/her understand & manage assigned works in the context of the social environment of the customer. These tasks will require the individual to take responsibility of his/her own work and learning and full responsibility other’s work & learning. Individual at this job does not work under supervision, as needed at Level 3 & is responsible for his/her own learning. He/she is fully responsible for other’s work & learning (unlike not/partially as in level 4/5). He/she is also sometimes fully responsible for the output of the group. Therefore, this QP is justified to be pegged at Level 7. Summary of other evidence (if used): Validated by Industry council through various workshops and through training provider stake holders
NSQF_-_SIMPLIFIED_SSC_Q2401_V3.docx