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Pharmacy Insurance Coordinator
2 weeks ago
Saudi German Hospital Ajman is hiring for **Pharmacy Insurance Coordinator**
**1.0.JOB SUMMARY**:
Dealing all insurance policy requirements such as coverage, deductible, copayment
and all other insurance related issues.
**2.0. SCOPE**:
Works in the Pharmacy under the direction of Pharmacy Manager. Serves as runner for administrative needs in the assigned area.
**3.0. PRINCIPAL CONTACTS**:
employees, Department Heads Patients, Representative of Insurance Companies, SGH
- **4.0. JOB DESCRIPTIONS**:_
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.
0 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
O.JOB SPECIFICATIONS:
5.1. Education: Diploma or Bachelor Degree related to medical field(science, nursing------etc)
5.2. Experience: 2 years minimum experience as insurance in a hospital or Pharmacy.
3.1. Knowledge/Skills: Thorough knowledge of MOH policies and regulations regarding
pharmaceuticals. Can deal with colleagues and other subordinates within collaborative
departments with regards to Pharmacy issues.
5.3. License: Not required
5.4. Languages: Proficient in English and Arabic. Spoken Arabic is preferred.
5.5. Personal Requirement: Evidence of good health and proper grooming; active and pleasant
personality; of good moral character; possess initiative; and tactful.
5.6. Job Conditions: Can handle job efficiently without supervision.
Pay: AED3,000.00 - AED4,000.00 per month
Application Deadline: 18/01/2025
Expected Start Date: 03/02/2025
