Medical Reviewer

الوصف الوظيفي
- Evaluation & approval of in-hospital pre- authorization request in respect of medical necessity and appropriateness on daily basis.
- Evaluation & approval of outpatient pre-authorization request cases in respect to the medical necessity and appropriateness and check them in the system to insure high quality and correct services on daily basis.
- Responding to all medical phone inquiries on daily basis.
- Online claims auditing on daily basis.
- Manage the day to day functions of the pre-authorization and implementing existing Policies and Procedures in cost-effective way to customers.
- Monitor and review IN & outpatient claims in order to ensure pre-authorization objectives are met in a timely and efficient manner and in adherence to procedural and contractual requirements
- Monitor all claim indicators related to the key performance indicators of the department in order to contain the cost in cost-effective way.
- Perform studies and analyses in order to provide reports on status of claims and deviations from company procedures/policies to assist management decision making.
المهارات
·Bachelor degree in any healthcare segment (staff nurses and MD).
·Minimum of 2 years experience in any healthcare segment. (Staff nurses and MD).
·Preferably Minimum of 1 year experience in a TPA or insurance company.
·Excellent communication skills.
·Excellent English language.
·Planning and organizational skills
.Flexibility..
تفاصيل الوظيفة
منطقة الوظيفة جدة, المملكة العربية السعودية
قطاع الشركة التأمين
طبيعة عمل الشركة صاحب عمل (القطاع الخاص)
الدور الوظيفي الطب والرعاية الصحية والتمريض
نوع التوظيف غير محدد
الراتب الشهري غير محدد
عدد الوظائف الشاغرة غير محدد
المرشح المفضل
المستوى المهني مبتدئ الخبرة
منطقة الإقامة جدة,المملكة العربية السعودية
الشهادة بكالوريوس/ دبلوم عالي

*** تقدم على الرابط التالي : Apply on the following link ***
https://www.bayt.com/ar/saudi-arabia/jobs/medical-reviewer-4085770/