MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Senior Medical Officer who will evaluate medical authorizations and provide decisions for outpatient services mainly through online, faxes, emails and phone calls and will assist our service providers with their inquiries.
Your Job
- Provide overall guidance about the medical cases review, evaluation and authorization activities ensuring compliance with established policy guidelines.
- Revise & confirm application of TOB, PIC Exclusion List & policy amendments with concerned departments.
- Support in Training of New MCC members regarding P&P, medical guidelines and chronic cycle.
- Respond to all clients queries though Fax, email, and phone calls etc.
- Responsible for approval and entry of all Chronic modules (New & Renewed policies), support in communication with account management Team regarding approved & rejected cases per policy.
- Review New monthly chronic Incidents regarding Technical (C.F, duplication, ICD) & Medical Guidelines (Medical assessment).
- Request Re-consultations for specific cases (not medically justified, Irregular dispensing manner), communicate and follow-up the cases that require Re-consultations with the account management Team according to agreed deadlines.
- Revise and request exceptions renewal per policy & per members with the account management team.
- Review medical trends, identify fraudulent cases and notify the medical team leader to minimize abuse of medical insurance.
Your Profile
- Bachelor's degree of Pharmacy/ Dentistry.
- 3-5 years of experience in their educational field.
- Previous experience in the insurance field is a plus.
- Fluent English language
- Excellent verbal and written communication skills
- Time management skills
- Analytical and problem-solving skills
- Ability to handle stress.
- Decision Maker.
