Job Description

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.