Medico Dictaminador

Location : Guadalajara (On-Site, FTE) - open to relocation

Compensation : Competitive remuneration (approx. $23,000 MXN / month gross), annual performance-based bonus, and standard industry benefits.

Key Responsibilities :

• Review admissions and service requests (prospective, concurrent, and retrospective) to determine medical necessity and compliance with reimbursement policies.
• Collaborate with physicians and healthcare teams to ensure appropriate documentation, case justification, and discharge planning.
• Identify and address inappropriate admissions or denials; notify healthcare teams of reimbursement-impacting decisions.
• Act as liaison between the Physician Advisor and attending physicians to support accurate documentation and clinical appeals.
• Support denial resolution processes and ensure all communications with payors are properly documented and escalated when needed.
• Communicate efficiently with third-party payors, physicians, patients / families, and internal stakeholders.
• Participate in utilization and peer review meetings, providing insight on clinical documentation, treatment duration, and justification.

Required Competencies and Skills :