Clinical Hospital Relations Doctor (CHR)

Job Title:	Clinical Hospital Relations Doctor (CHR)
Education:	Bachelor’s Degree
Location:	Egypt, Cairo
Category:	Medical/Healthcare
Description:	Monitors 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. Set, and continuously update, the criteria for investigation and case auditing in coordination with the relevant department and units. Set schedules for routine regular case auditing. Ensure Provider Networks to meet customer and business needs through expert knowledge of market providers. ( Ensure Cost effectiveness for Hospital admitted cases ( non PD approved cases ) Assist and help in medical complex cases to ensure proper medical case management for the insured members and negotiates discounts on same. ( getting marketing insights related to other insurance companies prices, discounts, special benefits ) Implement strategic action plans & auditing support. Identify areas for improvement on and operational effectiveness & efficiency. Create extra methods and plans for the unit enhancement and progress Responsible for the policies and procedures unit hierarchy Represents Med-Right in front 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 Med-Right team ( Clinical Excellence team & approval team ) Maintain healthy professional relationship with key persons in assigned providers ( admission office, insurance office, Billing team ) Ensures compliance with legal and regulatory requirements Share our Medical practice guidelines with our providers to improve request processing cycle with less time consumption and better quality
Qualifications:	Proficient knowledge of the Country’s healthcare Insurance market. Preferable Previous Health Insurance Experience Bachelor Degree in Medicine and Surgery Preferable with post graduate Studies Excellent communication and listening skills Confidence and presentation skills Ability to analyze and research information Ability to explain complex information clearly and simply Good negotiation skills – Analytic abilities Strong problem solving abilities Good writing skills, especially for formal letters and email messages Good written and spoken languages: Arabic and English Expert knowledge of all medical insurance policies, Services pricing fee & billing policies Shows good knowledge of Microsoft office applications
Contact:	Apply

Collected from: