Obtain medical approvals from third part insurance companies through proper commination, documentation in a timely manner before render services to the patients.
Major Duties and Responsibilities:
- Send approval requests through insurance portals or insurance fax system.
- Answer queries regarding approval requests and update patients about approval request status.
- Send SMS to the patient regarding approval status.
- Coordinate with physicians to get further information or report if requested by insurance companies.
- Update approval status in Hospital HIS system such as send, waiting, approved rejected.
- Update HIS with details about rejection or partially approved requests.
- Enter approved cost, Length of stay approved, partial approvals or rejected items in HIS system with detailed notes for admitted patients.
- Inform case manager, approval manager and admission manager regarding immediate stoppage of patient coverage during inpatient stay.
- Communicate with Rowing insurance doctors and update inpatient approval status.
- Confirm approved services, with real invoice after service to make sure obtained adequate approval.
- Eradicate pending approvals after requested from physicians and report unattended approvals to approval manager.
- Prepare daily report for all approval activities.
- The claim document should be handed over to business center department daily basis.
- Refers all inquiries for preparing response for the financial rejections done by the contracted companies to Head of Rejection Management.
- Ensures proper flow of documents supporting the changes and reporting the short comings to the concerned.
- Reviewing all contracts from the financial point of view prior to accreditation from the administration.
- Correlation between Finance, Patient Services, Pharmacy and other concerned departments offering the service about application of the terms of contracts and documents
- Performs additional tasks and duties as assigned by Superiors.
- High school certificate
- Diploma in any medical/ accounting course highly preferred
A minimum of:
- Three (2) years’ experience in Approval field
- Good Communication skills in English and Arabic Language.
- Computer literate (MS office)
- Familiar with medical Terminology.