Medical Claims Officer FSR # 348 Maternity Cover

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Job Title:Medical Claims Officer FSR # 348 – Maternity Cover

Location: Amman

Background:

International Medical Corps is a global, humanitarian, nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs. Established in 1984 by volunteer doctors and nurses, International Medical Corps is a private, voluntary, nonpolitical, nonsectarian organization. Its mission is to improve the quality of life through health interventions and related activities that build local capacity in underserved communities worldwide. By offering training and health care to local populations and medical assistance to people at highest risk, and with the flexibility to respond rapidly to emergency situations, International Medical Corps rehabilitates devastated health care systems and helps bring them back to self-reliance.

Job Summary:

The Medical Approval Doctor at International Medical Corps is responsible for reviewing and approving medical request and treatments for patients in field operations. This includes evaluating patients records, consulting their medical professionals, and making decisions on the appropriate course of care. The Medical Approval Doctor also plays a key role in ensuring the quality of care provided in the field, and may be involved in the development and implementation of medical protocols and guidelines. Additionally, this role may involve working closely with other organizations and government agencies to coordinate medical services and respond to emergencies. Overall, the Medical Approval Doctor plays a vital role in ensuring that patients receive the best possible care in difficult and challenging environments.

Main Tasks and Responsibilities:

• Communicate with hospital to prepare invoices.
• Registration of claims upon receive.
• Make sure that all claims’ documents and details are complete (original invoices, medical reports, diagnostic procedure results, copy of referral)
• Medical examination to ensure that the treatments and procedures match the diagnosis.
• Examine whether the incurred treatments and procedures are covered under the referral letter conditions,
• Assure that treatments and procedures didn’t exceed the referral estimated cost.
• Entering all claims details into system.
• Compare the approval given with actual claim.
• Applying the agreed price list, package deal and discounts for each provider.
• Correspondence with all Providers.
• Monthly Reconciliations with all medical providers.
• Entered the audited claims on the claims system.
• Prepare monthly detailed reports for each medical provider
• convert entered and audited claims to financial department and coordinate with finance for payments.
• prepare the required statistical reports

Minimum Requirements:

• Bachelore degree in Nursing with two years of experience in Audit,
• or Diploma degree in Nursing with 5 years of experience in audit.

Child Safeguarding:

International Medical Corps is committed to child safeguarding and expects all employees to strictly adhere to the values and principles of the International Medical Corps Child Safeguarding Policy.

Code of Conduct

It is our shared responsibility and obligation to prevent matters involving Sexual Exploitation & Abuse, Trafficking in Persons, Child Safeguarding and any suggested violation to our Code of Conduct, which may involve Conflicts of Interest, Fraud, Corruption or Harassment. If you see, hear or are made aware of any suggested activities then you have an obligation to report.

Compliance & Ethics

Promotes and encourages a culture of compliance and ethics throughout International Medical Corps. As applicable to the position, maintains a clear understanding of International Medical Corps’ and donor compliance and ethics standards and adheres to those standards. Conducts work with the highest level of integrity. Communicates these values to staff and to partners and requires them to adhere to these values.

Equal Opportunities

International Medical Corps is proud to provide equal employment opportunities to all employees and qualified applicants without regard to race, color, religion, sex, sexual orientation, national or ethnic origin, age, disability or status as a veteran.

This job description is subject to periodic review and adjustment in order to achieve International Medical Corps goals in Jordan, and any changes to the job description will be discussed and agreed

“I hereby certify that all the information provided through the application and CV are accurate and the supportive documents are available upon request, any false information provided will cause cancelation of the application and applicant will be subject to legal action”.

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