Medical Approval Coordinator - 4001

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

• 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.

• 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.
• Customer service experience and education courses
• Must have tact, courtesy and public relation skills.