The Internal Organization Of Managed Care Organizations Essay

The Internal Organization Of Managed Care Organizations Essay

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As the managed care organizations continues to expand, and as the affordable care is taking root in the United States. The country in its entirety relies on managed care to assure access, manage costs and provide comprehensive services. Hence, it is imperative that the Managed care departments work in Unisom to achieve optimal health care for their customers. Therefore it is important to analyze and understand the internal organization of managed care organizations (MCOs).
The internal operation of a typical managed care organization consists of the following:
Marketing and sales department
Enrollment and billing
Claims administration
Member services
Finance
Actuarial
And underwriting
Information technology
Marketing and sales department
Starting with the executives of MCOs, their major functions include assembling and maintaining networks of providers to deliver services, overseeing the marketing those services as a health plan, assist in supplying financial services (including processing claims), and evaluate services. These administrative functions may all exist within a single organization, or they may be provided through separate organizations or combinations of organizations.
The key to successful administrative processes within a managed care organization is a well-coordinated workflow and excellent administrative leadership. Therefore, at the core of the managed care organizations’ services are their clients, therefore are no clients available to buy their products there will be no MCO. To achieve this goal the marketing departments within a managed care organization (MCO) creates a strategy for easily navigating the health insurance market while building infrastructure to sell the MCO’s services or products ...


... middle of paper ...


... payment process preferred by the individual health care providers. Finally, the information is achieved for reference purposes.
Overall, the functions of the claims department require collaboration with other departments within the organization to succeed; because their functions, if well executed could impact the financial status of the MCO, likewise, the activities of other departments may influences or affect the duties of the claims department.
Member services
The member services department is vital to the MCO’s organization since they interface between the members of the organization and all the departments within the organization. The member service department with the assistance of the other departments provides general information to their member, routinely communicate with members about the new policy change, and provide proactive outreach to members.

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