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Job Description
- Monitor providers billing and utilization behaviors to identify opportunities for improvements in clinical practice and billing.
- Provide guidance and expert medical direction to the different departments and units concerned with cost containment (e.g. claims, approval, provider’s relations, and medical analysis….etc.).
- Investigate and audit medical records within assigned medical providers.
- Apply and continuously update, the criteria for investigation and case auditing in coordination with the relevant departments and units.
- Set schedules for routine regular case Monitoring.
- Assist and help in medical complex cases to ensure proper medical case management for the insured members and negotiates discounts.
- Implement strategic action plans & auditing support.
- Identify areas for improvement on and operational effectiveness & efficiency.
- Represents Unicare infront of selected cases and providers during admission period
- Revising the patient file and final claim after patient discharge to make sure there are no services/ days not approved by Unicare team (approval team).
- Share our Medical practice guidelines with our providers to improve request processing cycle with less time consumption and better quality
Job Requirements
- Physician is a must
- Strong medical background
- Hands on experience in handling medical cases and dealing with all managerial and clinical levels
- Excellent communication and negotiation skills
- Ability to solve complex problems
- Fast decision maker specially in a fast paced and challenging environment
- Flexibility in working hours & conditions
- Ability and willingness to work outside the office more than 90% of the job
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