Medical Claims Specialist

1 day ago


Muscat, Muscat, Oman beBee Careers Full time
Job Title: Medical Claims OfficerMedical Claims Officer Job Description:

This role involves adjudicating cases and authorizing decisions within stipulated turnaround times while ensuring the highest quality standards in accordance with policy terms and conditions.

You will perform comprehensive file reviews, including multidisciplinary notes, TPR charts, physician orders, lab reports, radiology reports, drug charts, consultation notes, nursing notes, and progress notes.

The ideal candidate will request necessary medical documentation or identify missing documents essential for decision-making. Additionally, you will review DRG Severity of Illness (SOI) in line with CPT and ICD code revisions, including discussions with treating doctors and medical coders if required.

Other responsibilities include conducting utilization reviews for DRG and FFS cases, reviewing claims according to CPT and ICD coding guidelines, and adhering to cost containment protocols for medical management cases.



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