Pharmacy Insurance Coordinator

Evaluate rejected claims for possible resubmission. Working with problem claims & denials. Explaining coverage of medical benefits to patients when req...

Evaluate rejected claims for possible resubmission. Working with problem claims & denials. Explaining coverage of medical benefits to patients when req...

Fursaty

Pharmacy Insurance Coordinator

Saudi German Hospital

Healthcare

Posted on 30 Jan, 2024
Apply before 08 Mar, 2024


Experience

2 – 5 years

Location

Ajman

Qualification

Bachelor's Degree

Nationality

Unspecified

Gender

Any

Job Sector

Healthcare

Job Type

Full Time

Salary

Unspecified

Vacancies

Unspecified

Job Description

  • Evaluate rejected claims for possible resubmission.
  • Working with problem claims & denials.
  • Explaining coverage of medical benefits to patients when required.
  • To maintain and update records related to pre-approvals and reconciliation.
  • To coordinate and co-operate with colleagues of the same department and other related departments for the smooth running of Insurance operations.
  • 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.
  • Calling the insurance companies for the approval of the patient services.
  • Handling approval for costly medicine.
  • Collect and analyze claims data and resolve efforts delayed claims processing issues.
  • Taking medical approval online and verbally.
  • Ensure all the approval codes are attached and verified.
  • Proficient in DHPO portal, Handling E-Claims and E-Prescription.
  • Interacting with insurance companies to resolve direct billing and reimbursement claims and  issues.
  • Monitor invoice processes to ensure invoices from external medicinal providers are being billed as per agreed tariff and discounts and under the exclusion policy given by the insurance company.
  • Giving reliable approvals in line of hospital and insurance protocols.

Job Skills

  • Bachelor's degree in pharmacy (B.Pharm) or equivalent.
  • Recommended knowledge of coverage of insurance companies and exclusions.
  • Skills and ability to relate to approvals and denials of insurance company.
  • Proven computer skills essential.

Job Location

Ajman

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Saudi German Hospital

Saudi German Hospital

  • Company category
    Healthcare
  • Employees
    51-200
  • Location
    Dubai, United Arab Emirates

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