Medical Approval Coordinator

Job Summary

Obtain medical approvals from third-party insurance companies through proper communication and documentation in a timely manner before rendering services to patients.

Major Duties and Responsibilities

• Ensure, through actions either directly or indirectly, that a high quality of medical treatment, compassion, and understanding is provided to every patient served at CARE Hospitals and Clinics.
• Send approval requests via insurance portals or fax systems.
• Answer queries regarding approval requests and update patients about their approval status.
• Send SMS notifications to patients regarding approval status.
• Coordinate with physicians to obtain further information or reports if requested by insurance companies.
• Update approval status in the Hospital HIS system, such as 'sent', 'waiting', 'approved', or 'rejected'.
• Update HIS with details about rejection or partial approvals.
• Enter approved costs, length of stay, partial approvals, or rejected items in the HIS system with detailed notes for admitted patients.
• Inform case managers, approval managers, and admission managers about immediate stoppage of patient coverage during inpatient stays.
• Communicate with insurance doctors and update inpatient approval status accordingly.
• Confirm approved services with the actual invoice after service to ensure proper approval.
• Address pending approvals upon physician requests and report unattended approvals to the approval manager.
• Prepare daily reports of all approval activities.
• Hand over claim documents daily to the business center department.
• Refer all inquiries related to financial rejections by contracted companies to the Head of Rejection Management.
• Ensure proper flow of documents supporting changes and report shortcomings to concerned departments.
• Review all contracts from a financial perspective prior to accreditation by administration.
• Coordinate between Finance, Patient Services, Pharmacy, and other departments regarding contract terms and documentation.
• Perform additional tasks and duties as assigned by superiors.

Reporting to

• Approval Manager

Qualifications:

Education

• High school certificate
• Diploma in medical or accounting courses highly preferred

Minimum Experience and Skills:

• At least two (2) years of experience in the approval field
• Good communication skills in English and Arabic
• Proficient in MS Office
• Familiarity with medical terminology
• Customer service experience and related education courses
• Diplomacy, courtesy, and strong public relations skills