Pharmacy Insurance Coordinator

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.