Saudi German Hospital
Company: Saudi German Hospital Dubai
Positions: Pharmacy Insurance coordinator
Branch: Ajman, UAE
Duties & Responsibilities :
a) Evaluate rejected claims for possible resubmission
b) Working with problem claims & denials
c) Explaining coverage of medical benefits to patients when required
d) To maintain and update records related to pre-approvals and reconciliation.
e) To coordinate and co-operate with colleagues of the same department and other related departments for smooth running of Insurance operations.
f) Determine the insurance policy coverage, including, but not limited to, diagnosis, clinical procedures, investigations, medications, limits of coverage, patient responsibility, referral authorization requirements (approvals) and lead-time thereof Ensure patient information is accurate including billing information
g) Calling the insurance companies for the approval of the patient services
h) Handling approval for costly medicine.
i) Collect and analyze claims data and resolve effors delayed claims processing issue.
j) Taking medical approval online and verbally
k) Ensure all the approval codes attached and verified
l) Proficient in DHPO portal, Handling E-Claims and E-Prescription.
m) Interacting with insurance companies to resolve direct billing and reimbursement claims issues.
n) Monitor invoice processes to ensure invoices from external medicinal providers are being billed as per agreed tariff and discounts and in accordance with the exclusion policy given by insurance company
o) Giving reliable approvals in line of hospital and insurance protocols.
Closing date: Feb 10, 2024
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