Job Description

Main Tasks

• Serve as the acknowledged expert and information source for staff
• Follow medical guidelines, practices and regulator ( AI ) instructions.
• Setting goals and Priorities for medical team and Provide feedback about areas for improvement
• Respond to employee questions / concerns on individual basis as needed
• Conduct and schedule staff development opportunities
• Organized Establishment of effective cost containment plans, Case management and Cost Saving for jumbo cases and high cost management ( referral and special discount )
• Update Network Department with providers having issues with Codes and Price, Referral Matrix and Centers of Excellence
• Raise suspected fraud and abuse provider to Network and Fraud, Waste and Abuse ( FWA ) departments
• Provide accurate analytic Data; insights and recommendations to multiple stakeholders
• Monitor adherence to policies and established procedures
• Meet the qualitative requirements and continuously work to improve quality of approvals.
• Monitoring of the daily dashboard to ensure adherence to SLA, TAT and the productivity
• Assist clients with escalated queries and provide suitable query resolution for other departments
• Ensuring participative leadership and strong communication within the team
• Coaching and team Development with quality assurance and trending
• Regular evaluation and root cause analysis for department enhancement
• Increase automation percentage and accuracy and review the rules
  

Minimum Requirements

• Bachelor of Medicine and Bachelor of Surgery MBBS
• 8+ years of experience in a mid-to-large sized organization in the similar role.
• SCFHS
• Typing and communication skills in English & Arabic.
• Physically fit to carry out duties.