Applications are invited for recruitment of various administrative positions or jobs in MHIS Meghalaya.
Megha Health Insurance Scheme (MHIS) Meghalaya is inviting applications from eligible candidates for recruitment to the posts or jobs of Medical Officer.
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Name of post : Medical Officer
No. of posts : 1
Salary: Not less than Rs, 75,000 and may increase with experience.
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Qualification & Experience :
- M.D/M.S. /Dip/MBBS from a recognized University. (Duly registered with theMedical Council of India)
- Experience with Hospital & Healthcare Administration/Health Insurance.
- History of Services in the Government Health Department would be an added advantage.
- Hands-on experience with office software packages (MS Word, Excel, PPT, etc.).
- Willingness to travel for work purposes.
Selection Procedure : A walk-in-interview will be held on 12th January 2024 at 11:30 AM in Office of the Chief Executive Officer, State Nodal Agency, MHIS, Shillong
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Job Roles :
a) Empanelment – Implement criteria for empanelment of hospitals in various categories. Manage the empanelment and de-empanelment process. To monitor the functioning of the scheme in all empanelled hospitals. To assist hospitals empanelled outside the State and Northeast Region.
b) Review compliance by the insurance company and empanelled health care providers with the defined claims process and the settlement of claims.
c) Enquire about complaints related to the hospital and recommend disciplinary action to the Chief Executive Officer.
d) Review and monitoring of claims data along with the Claims Officer for claims received from the Insurance Company and the empanelled health care provider.
e) Audit – Conducting monthly claims audits in empanelled hospitals. Conducting regular Hospital audits, clinical audits, fraud control, etc. in all empanelled hospitals. (In coordination with the M&C officer).
f) Discuss with hospitals and persuade them to observe the key public safety and quality indicators.
g) Compile and analyze the reported data to highlight patient safety and quality trends.
h) Develop concept notes, and project proposals in Blocks, Districts vis-à-vis State, and preparation of reports for the same.
i) Monitor package rates by the National Health Authority and assist empanelled hospitals in claim
management.
j) Study the pattern of diseases in empanelled hospitals through the data derived from MHIS & AB PMJAY patients admitted in such hospitals and strategically plan key approaches for MHIS & AB PMJAY activities.
k) Support the development of STGs and process documentation for covered packages.
l) To monitor the Claims under MHIS & AB PMJAY, control and prevention of medical fraud that may arise from various empanelled hospitals.
m) To monitor the Scheme and its fundamental dealing with the day-to-day healthcare of the beneficiary in the empanelled hospitals.
n) Portability – To oversee the Critical Illness care/Portability Cases under the Scheme and recommendations for referral cases outside the State and North East region.
o) To look into the Critical Illness claims management maintaining of the report submitted by the Insurance Company and Empanelled Health Care.
p) Medical Officer to follow up on approval and scrutinization of Claims under critical care illness claims.
q) Ensure Claims are settled for all hospitals that are empanelled within and outside the State under Critical illness.
r) To conduct Training and Capacity Building of Doctors at empanelled hospitals. (In coordination with HR Manager).
s) Coordinate with other Health department departments and other programs that fall under the Health & Family Welfare department.
t) Approval of Unspecified Surgery Packages.
u) Member of State Anti-Fraud Unit (SAFU)
How to apply :
Candidates may appear for the interview with CVs, original and self-attested copies of all relevant documents
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