Medical Doctor - Medical Rules Officer

GlobeMed Group, the largest Healthcare Benefits Management company in the MENA region is looking for a Medical Doctor to assist in the setup and upkeep of the medical rules dictionaries as well as in the know-how transfer of Medical Expert System to all GlobeMed operations.

Duties & Responsibilities:

• Preparing and maintaining automated medical rules based on the different versions of coding lists: ICD9, ICD10, ICD10-M, ICD10-CM, CPT4, ACHI, HCPCS, and DRGs (used for billing)...
• Setting-up and maintaining all the dictionaries based on the different healthcare programs at all GlobeMed operations; as well as overall updates and changes in case of new requests and in case of any new emerging coding system(s).
• Preparing and deploying General Exclusions dictionaries for proper policy implementation at all GlobeMed Operations.
• Updating the process of existing dictionaries in case of new emerging coding list(s) or enforced requirements by regulators in operations.
• Preparing and maintaining all IN- & OUT-Hospital Medical Expert Systems algorithms & dictionaries (including clinical pathways) for all GlobeMed Operations.
• Performing testing of Medical expert system rules to monitor quality and appropriateness through Quality Assurance process.
• Responding to any daily requirements of the operations (i.e. remove, add, update, and inquire about available info...).
• Collecting medical requirements from operations and share those with the Medical Rules team unit for proper follow-up and process.
• Identifying problematic areas in the actual processes used and reports back to the Medical Rules team unit for corrective measures and process for re-engineering of some of the rules.
• Providing disease coding support in various applications.
• Maintaining confidentiality of all prepared dictionaries.
• Reading and studying allocated Manuals and following the corresponding certification process.
• Ensuring effective team communication throughout the Medical Rules Unit.

• Medical Doctorate, with official registration at the Lebanese Order of Physicians (LOP)
• preferred to have knowledge of the medical coding procedure and the different coding systems and standards: ICD9-CM, ICD10, ICD10-AM, ICD10-CM, CPT4, ACHI and DRGs...
• Computer literate with good MS Office skills
• Fluent in English and Arabic, French is an asset
• Good written and oral communication skills
• Good organizational and follow-up abilities
• Inquisitive and meticulous about details
• Confidentiality