About the Job
• Monitor 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.
• Apply and continuously update, the criteria for investigation and case auditing in coordination with the relevant departments and units.
• Set schedules for routine regular case Monitoring.
• Assist and help in medical complex cases to ensure proper medical case management for the insured members and negotiates discounts.
• Implement strategic action plans & auditing support.
• Identify areas for improvement on and operational effectiveness & efficiency.
• Represents Unicare infront 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 Unicare team (approval team).
• Share our Medical practice guidelines with our providers to improve request processing cycle with less time consumption and better quality
3 to 5 years
About this Company
Established in 1998 and founded by Dr. Amr Hamza (CEO) aiming to design, implement and manage health care programs for many different clients, whether governmental, public sector, institutions, private companies or multinational organizations.