Medical Approval Coordinator

  • Full Time
  • Riyadh, Saudi Arabia.
  • No. of Vacancies: 1
  • Experience: 1 - 3 Year
  • Posted 10 months ago

Job Summary:

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.

Reporting to:

Approval Manager

Qualifications:

Education:

  • 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.

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