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Job Description
- Act as a point of contact for all approval requests for internal and external patients with all insurance companies, and resolve issues related to rejected and pending approvals, and ensure fast service.
- Ensure that patient insurance policy is eligible and covers the required treatment, stay, or operations to avoid rejections.
- Ensure the delivery of best-in-class service for patients, provide clarification regarding policy, medical rejection, pending requests to contribute to patients satisfaction and overall SGH image.
- Review all patients' requests related to medical and pharmaceutical, diagnosis, and RMI and ensure that the insurance policy covers them.
- Ensure following CCHI, SFDA protocol, policies and procedures when executing insurance activities.
- Ensure the documentation of all approval activities to ensure the accuracy and completeness of working papers, analysis and results to support findings and recommendations.
- Ensure uploading the ' Table of Benefits' in the hospital system for IN/OUT patient, with an accuracy of patient deductible, approval limit, service inclusions/exclusions, and ensure all contracts/policies are assigned to the correct price.
- Review and submit all approvals on-time.
- Provide insurance companies with requests on time and getting approvals from them also follow up all pending requests.
- Commit with submitting all requests in the due time
- Coordinate between insurance companies and hospitals in the case of emergencies to deliver the service to the patients and then get Approval in the allowed time "within 24 hrs. of admission".
- Confirm and analyze insurance patients' data with the submitted data to avoid any confusion, fraud, or rejection
Job Requirements
- At least one Year of Experience in Approvals
- Medical Educational Background is a Must
- strong communications skills
- Pervious Experience in KSA market will be a Strong Asset
