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Clinical Hospital Relations Doctor (CHR)

Maadi, Cairo
Posted 4 years ago
134Applicants for1 open position
  • 69Viewed
  • 0In Consideration
  • 0Not Selected
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Job Details

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Job Description

  • Monitors 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.
  • Set, and continuously update, the criteria for investigation and case auditing in coordination with the relevant department and units.
  • Set schedules for routine regular case auditing.
  • Ensure Provider Networks to meet customer and business needs through expert knowledge of market providers. ( Ensure Cost effectiveness for Hospital admitted cases ( non PD approved cases )
  • Assist and help in medical complex cases to ensure proper medical case management for the insured members and negotiates discounts on same. ( getting marketing insights related to other insurance companies prices, discounts, special benefits )
  • Implement strategic action plans & auditing support.
  • Identify areas for improvement on and operational effectiveness & efficiency.
  • Create extra methods and plans for the unit enhancement and progress
  • Responsible for the policies and procedures unit hierarchy
  • Represents Med-Right in front 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 Med-Right team ( Clinical Excellence team & approval team )
  • Maintain healthy professional relationship with key persons in assigned providers ( admission office, insurance office, Billing team )
  • Ensures compliance with legal and regulatory requirements
  • Share our Medical practice guidelines with our providers to improve request processing cycle with less time consumption and better quality

Job Requirements

  • Proficient knowledge of the Country’s healthcare Insurance market.
  • Preferable Previous Health Insurance Experience
  • Bachelor Degree in Medicine and Surgery
  • Preferable with post graduate Studies
  • Excellent communication and listening skills
  • Confidence and presentation skills
  • Ability to analyze and research information
  • Ability to explain complex information clearly and simply
  • Good negotiation skills - Analytic abilities
  • Strong problem solving abilities
  • Good writing skills, especially for formal letters and email
    messages
  • Good written and spoken languages: Arabic and English
  • Expert knowledge of all medical insurance policies, Services pricing fee & billing policies
  • Shows good knowledge of Microsoft office applications

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