Job Description
PHARMACY INSURANCE COORDINATOR
Assists the pharmacists on all Insurance issues and coordinates with internal and external customers and Insurance Companies with direct approval requirements for prescriptions with American Hospital Dubai
DUTIES AND RESPONSIBILITIES: Quality and Accuracy:
- Coordinates with the following appropriate personnel to ensure that all the formalities as agreed with the insurance companies are followed to minimize objections from them and delays in clarifications to the insurance companies:
- Patient Relations
- Nursing
- Physicians
- Monitors and follows up on prior e-authorization for outpatient/inpatient services.
- Takes approval for prescriptions from Outpatient Clinics.
- Sends approval and follow-up for E-claim prescriptions.
- Follows up for high-cost approvals with insurance companies, physicians, and the nursing team.
- Updates and documents all insurance approval requests appropriately.
- Communicates with patients, physicians, nursing, and pharmacy teams regarding the status of approvals according to the process efficiently.
- Follows up on approvals for satellite clinics and provides appropriate feedback.
- Performs home delivery processing approvals on time.
- Prepares home delivery medication for dispatch and maintains appropriate logs as per policy and Dubai Health Authority regulations.
- Responds to patient inquiries and CRMs on time.
- Collaborates with Revenue Cycle Management and Insurance team for necessary approvals.
- Conducts training for new staff members about insurance guidelines.
- Works under the supervision of the immediate manager.
- Monitors the pending list daily.
- Makes accurate, thorough, and appropriate work a priority.
- Identifies and analyses problems, takes action to resolve them, applies sound judgment, and takes responsibility for their resolution.
Quantity and Organizational Skills:
- Handles complaints feedback and responds to emails within 24 hours.
- Anticipates and sets priorities to support department needs and follows policies and procedures for achieving them.
- Makes accurate, thorough, and appropriate work a priority.
- Requests for out-patients are to be sent out within the same day.
- Performs tasks assigned from time to time.
Requirements:
- Diploma in Pharmacy or in a related field
- Minimum of two (2) years of experience in the Outpatient Pharmacy field.
- Knowledge of insurance policies and protocols.
- Knowledge of insurance and eRx authorization processes.
- Knowledge of authorization requirements and other prerequisites of insurance companies.
- Knowledge of coverage of insurance companies and exclusions.
