Medical Approval Clerk

Job Summary

The Medical Approval clerk generates reports of all the medical services rendered to each and every insured company as well as for every individual of non-insured companies. Checks the same and effects the corrections whenever needed in computer entries. Make sure that all computer entries are submitted with their respective documents.

Major Duties and Responsibilities

• Ensures through his actions, either directly or indirectly, that a superior quality of medical treatment, compassion and understanding is given to every patient served at the CARE Hospitals and Clinics.

• Receives original documents, which ensures the medical service have been rendered to company patients in the Hospital on daily basis.

• Generates computerized invoices of all services provided to patients on monthly basis and classified by each corporate.

• Compares the same with original documents, corrects and modifies wrong entries or collects more documents from the concerned Departments in the Hospital whenever needed.

• After carefully checking the claims, prepares covering letters to be attached with the print out and signed by the authorized person i.e. Head of Approvals or Director of Business Center.

• The claim document should be handed over later to the Collection Dept within Finance Division after signing the recording book.

• 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.

• Uploading and coding all policy on the system (from the financial point of view) and coordination with the Medical Coordinator about the technical terms.

• Updating and maintenance for all the financial categories present in the computer, with periodic follow up.

• Correlation between Finance, Patient Services, Pharmacy and other concerned departments offering the service about application of the terms of contracts and documents

• Answering the queries of all services suppliers about the policy condition.

• Printing the monthly approvals reports.

• Printing the daily control reports like digital categories, update, changes, update patient and upgrade users

• Coordination with Q.I. and Medical Coordinator to do questionnaires about the documents, service performance and customers

• Performs additional tasks and duties as assigned by Superiors.

Reporting to

·         Head of Medical Approvals Management

Supervises

• NONE

Qualifications:

Education

• Diploma with two (2) years experience.

• High School with four (4) years experience.

A minimum of:

• Three (3) years experience in Accounting field.

·         Good experience in a similar position especially in patient accounts.

• English and Arabic typing
• Computer literate (Excel and Word 2000)
• Good knowledge of English language.
• Familiar with medical English language.