Planning & Monitoring Process - Report any errors found or observed with in system, filing& coding flow that may hinder the approval process or data documentations and suggest recommended resolution accordingly to support the quality of Andalusia services.
Operation Excellence Process - Receive medical reports from the Medical Records Department and decide the approval cycle required for each patient according to their contracted company.
- Contact the contracting companies and facilitate the approvals pending to enable the patient’s transaction at Andalusia related to his/her assigned department to finally be accepted and covered with the minimum waiting time.
- Responsible for follow-up with each company’s concerned person regarding any issue hindering the approval finalization and work on solutions accordingly.
- Responsible for updating any internal databases, which electronically store and organize patients' records, billing details, and registration forms.
- Responsible for updating the list of accepted approvals of each company on the system along with their last status.
- Responsible for coding/filling all the approvals data to ensure easiness of reach and quality of further process.
- Check insurance information regarding each company and make sure each approval taken is compliant to the terms agreed and fulfilling all requested documents & data.
- Assure that all requirements necessary for each approval are present per individual.
- Ensure meeting legality for all approvals taken with variance of contract terms.
- Support his/her superiors with reports or requested data regarding insurance companies and their status.
Customer Satisfaction Process - Assist patients in obtaining and understanding medical benefits.
- Make sure patients of all contracted company are fully aware of their approval status whenever requested, support them in understanding their financial responsibility for services and next steps to be taken to enhance the process and ensure smoothness of all transactions.
Innovation Process - Suggest updates or modifications regarding the system, database, workflow, etc. whether to enhance the quality of process, reduce the waiting time or decrease the rejection rate per company.
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