Medical Officer Inpatient Precertification

Job description / Role Job Type Full Time Job Location Manama, Bahrain Nationality Any Nationality Salary Not Specified Gender Not Specified Arabic Fluency Not Specified Job Function Healthcare Company Industry Insurance Medical officer - inpatient precertification Responsible for managing the inpatient precertification cases while ensuring that departmental goals, timeline of activities, and compliance measures are met. What you do The precertification team is functional on a 24/7 basis. Therefore, the medical officer will be working on a flexible shift basis as per the schedule provided by the team leader. Adjudicates cases at inpatient precertification level, authorizes decisions within the stipulated turnaround time and with the highest quality standards in view of the policy terms and conditions. Performs complete file review with regards to multidisciplinary notes, TPR charts, physician order notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc. Requests any medical documentation or finds any missing documents which are essential in decision making. Performs review of DRG severity of illness (SOI) in line with revision of CPT codes and ICD codes, which are being up-coded by the provider; if required, discusses with the treating doctor and the medical coders. Performs utilization review for DRG cases and FFS cases with regards to, but not limited to, final bill review, consumables mark-ups, non-covered items/services, and overutilization of services. Performs review of claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH). Adheres to cost containment protocols for medical management cases. Refers cases for second opinion when deemed necessary to confirm the best mode of management; also for cost containment by recommending facilities within the member's network or options for home country treatment. AI readiness: Works 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 degree in pharmacy, dentistry, medicine, nursing, physiotherapy, or paramedics. 1-2 years of medical practical experience (reputable insurance provider, broker, or TPA experience is a plus) or entry level. Physically fit to carry out duties. Certified medical coder (preferable). Legally permitted to work in the country of operations. Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills. How we hire Agency statement: Allianz Partners does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered. Key benefits / What we offer Allianz Partners is a world leader in B2B2C insurance and assistance, offering global