Quality Lead, Dubai, UAE

This job is OPEN to APPLY for ALL Nationalities, unless otherwise specified.

Description

Medical Officer – Inpatient Precertification is responsible for managing the Inpatient Precertification cases while ensuring that departmental goals, timeline of activities, and compliance measures are met.

 

What you do

•Precertification team is functional on 24/7 basis. Therefore the Medical Officer will be working on flexible shift basis as per the schedule provided by the Team Leader.

•Adjudicates Cases at IP precertification level, authorizes decision within the stipulated turnaround time & with the highest quality standards in view with the policy terms and conditions.

•Performing complete file review with regards to the multidisciplinary notes, TPR charts, physician order’s notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc.

•Requesting any medical documentation or finding any missing document which is essential in decision making.

•Performing review of DRG Severity of Illness (SOI) in line with revision of CPT codes / ICD codes, which are being up-coded by the provider – if required discussion with the treating doctor and the medical coders.

•Performing utilization review for DRG cases and FFS cases with regards to and not limited to final bill review + consumables mark ups + non covered item/services + overutilization of services.

•Performing review of claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA,DOH/HAAD,MOH).

•Adhering to the cost containment protocols for medical management cases.

•Referring cases for second opinion when deemed necessary to confirm the best mode of management – also for cost containment to lesser Negotiating factor (NF) facilities within the member’s network or option for home country treatment.

•AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

 

What you bring

•Bachelor’s of Pharmacy / Dentistry / Medicine / Nursing / Physiotherapist / Paramedics

•01-02 years of Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus) OR Entry Level

•Physically fit to carry out duties.

•Certified Medical Coder [Preferable]

•Legally permitted to work in the country of operations.

•Physically fit to carry out duties.

•Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

DETAILS TO REGISTER FOR THIS JOB:

Make Sure Your CV is ATS-friendly.

https://careers.allianz.com/global/en/job/99122/Quality-Lead?utm_campaign=azgroup&utm_source=social&utm_medium=linkedinlimitedlistings


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We support the Far-Sighted, Growth-Oriented Vision announced by the UAE, Saudi Arabia, Qatar, Oman, Kuwait and Bahrain.


It's an exciting time and the next 30 - 40 years will see massive growth in jobs in the GCC countries.


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SOCIAL INITIATIVE:

We publish job vacancies on this Job Portal (https://www.dubai-jobs.me) and our Whatsapp groups (www.dubai-forever.com/whatsapp-jobs.html) for the benefit of job-seekers.


It is to help people who are searching for jobs from across the world.


This is a Social Initiative from our team @ dubai-forever.com, so please help in this Noble Task by Forwarding these jobs within your Network.


Do this GOOD DEED.


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