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Medical Officer

GlobeMed Egypt
Maadi, Cairo
Posted 5 years ago
188Applicants for3 open positions
  • 38Viewed
  • 2In Consideration
  • 0Not Selected
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Job Details

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Job Description

Job Summary:

Providing all the required administrative and adjustment tasks in addition to handling all the processing and auditing cycle of the Inpatient claims submitted by the healthcare service providers that GM Egypt network covers.

  • Validate and classify the claims and deductions per provider
  • Perform manual adjustment and medical audit of the Inpatient Claims as per the patient medical history and case
  • Determine, report and document any misuse that might take place.
  • Reporting the adjustment reasons and perform any needed additional adjustments.
  • Communicate with the patient services department for any mistakenly issued prior approvals and monitor the quality of issued approval requests.
  • Proper Filing and sorting of deduction reasons for inpatient claims.
  • Reporting and recommending new reasons for the adjustment of In-Hospital claims to be implemented.
  • Review system practices that reflect the contractual agreements with providers.
  • Review and Control the true reflection between the monthly statements and the enclosed claims.
  • Day to day tasks as assigned

Job Requirements

  • Bachelor degree in Medicine & Surgery is a MUST.
  • Good to Very Good command of the English Language.
  • Candidate age shall not exceed 35 years old.
  • Ability to commit to 40 hours per week (from Sunday to Thursday)
  • From 2 to 4 years of experience in the health care industry.
  • Strong Medical Knowledge is required preferably in orthopedics, anesthesia, internal medicine, cardiology or general surgery is required.
  • Master's degree is an asset
  • Excellent verbal and non-verbal communication skills.
  • MS office applications
  • Time management, Details oriented with strong analytical skills
  • People-oriented, result driven and good decision-making skills
  • Ability to work independently and as part of a team.
  • Previous Experience as a Medical Approvals doctor or in Medical Insurance field is a plus.
  • For Males, Military Service should be completed/exempted.

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