Job Description

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Work Assignment:

• Make the necessary administrative and medical clearance to provide medical decision for hospital admission claims as per UNICEF- TPA guidelines & protocols
• Coordinate with Medical Officers and the Medical Review Committee to provide correct decisions
• Visit patients and check on their Identity & their Medical status
• Inform the patient about all details related to his coverage (Excess, limitation, Rejection...)
• Support and coordinate referrals between supported hospitals and those received from other stakeholders
• Fill Concurrent review
• Check on false declarations and take necessary action
• Maintain the bills cycle within deadlines
• Identify cases for telemedicine, second opinion, and special treatment
• Monitor the length of stay, utilization, medical cases and their related costs
• Validate medical files
• Receive bills
• Handle customers, risk carriers, and providers’ requests
• Coordinate with Providers to resolve all problems encountered by our adherents
• Coordinate coverage collaboration in hospital between UNICEF- WHO- UNFPA- IOM and other actors based on leverage of each organization
• Coordinate with the UNICEF and TPA Supervisor for all complicated cases and check for cost saving
• Issue reports related to the work’s progress
• Preserve UNICEF and TPA Lebanon’s brand image among its stakeholders

  The tasks require daily presence and communications with the hospitals, clinical file reviews, visits to hospitalized patients and knowledge in insurance plans and management. Both aspects are not feasible to be implemented by UNICEF staff, operationally an dtechnically

  Minimum Qualifications Required:	A Bachelor of Science in nursing, laboratory, physiotherapy, mid wife, or any related education in the medical field	If Other, Enter Disciplines:
  Years of Experience required:	Minimum of 2 years of experience in TPA programs and services- Patient servicing processes- Policies & procedures Experience in coordination roles within a health context.
  Knowledge/Expertise/Skills required:	·         Strong coordination and communication skills. ·         Experience working with TPA and hospital work ·         Ability to work under pressure in complex, fast-paced environments. ·         Skilled in utilizing Microsoft Office tools, with a specific focus on Excel. ·         Experience in neonatal and pediatric care is an asset ·         Good written and verbal communication skills. ·         Experience in advocacy, coordination, and mobilization of health agendas. ·         Ability to work in a team and in a diverse work environment. ·         Negotiation- Follow up- Problem Solving- Analytical thinking- Organization- Time management

  1. Inception report and workplan	-          Review agreement, SOPs, and guidelines; submit detailed workplan and methodology
  Coordination and referral of cases.	-          Receive and follow up on cross hospital referrals, referrals from the sectors and interhospital case referrals -          Coordinate with Medical Officers and the Medical Review Committee to provide correct decisions -          Visit patients and check on their Identity & their Medical status -          Inform the patient about all details related to his coverage (Excess, limitation, Rejection...)
  Effective collaboration between hospitals, UNICEF and TPA	-          Support the necessary administrative and medical clearance to provide medical decision for hospital admission claims as per UNICEF- TPA guidelines & protocols -          Coordinate with the UNICEF and TPA Supervisor for all complicated cases and check for cost saving
  Data Verification	-          Check on false declarations and take necessary action -          Maintain the bills cycle within deadlines -          Monitor the length of stay, utilization, medical cases and their related costs -          Validate medical files
  Periodic data quality and summary reports	-          Monthly data quality checks, summaries, and documentation submitted to supervisor

Skills Required

• Analytical thinking