Pharmacy Insurance Coordinator/Trainee Pharmacist

Key Accountabilities:

Supervision and Compliance

• Works under the supervision of the immediate manager
• Comply with all the latest Joint Commission International (JCI) and Dubai Health Authority (DHA) government standards

Insurance Knowledge and Claims Submission

• Complete knowledge of insurance policies and protocols
• Accurate submission of claims and approvals
• Electronic claims (E-Claims) analysis prior to submission to insurance companies
• Electronic claims (E-Claims) analysis prior to submission to insurance companies by Finance

Claims Monitoring and Authorization

• Monitors the pending list on a daily basis
• Follow up on insurance approvals on a daily basis
• Monitoring and following up on prior electronic authorization for services
• Monitoring and follow up on prior electronic authorization for outpatient and inpatient services

Claims Reconciliation and Coordination

• Electronic reconciliation of claims paid and outstanding with insurance companies and coordination with Revenue Cycle Management (RCM) and Finance
• Electronic reconciliation of claims paid and outstanding with insurance companies and coordination with Finance
• Coordination with appropriate personnel to ensure that all the formalities agreed with the insurance companies are followed to minimize objections and avoid delays in clarifications. This includes coordination with:
  
  • Patient Relations
  • Nursing
  • Physicians
  • Finance

Rejections and Problem Solving

• Able to answer insurance queries, analyze rejections, and process claim re-submissions
• Work to avoid and minimize claim rejections
• Identify and analyze problems, take action to resolve, apply sound judgment, and take responsibility for their resolution

Billing and System Management

• Ensure all invoices and claims are captured on the pharmacy/hospital billing system

Communication and Work Ethics

• Makes accurate, thorough, and appropriate work a priority
• Inform and influence others through clear, concise expression of ideas and information in verbal and written communication

Other Responsibilities

• Perform any additional duties reasonably assigned by the organization or line manager, even if not explicitly listed in this job description, to meet operational needs and support specific objectives of your department and organization
• Comply with all organizational and departmental policies, procedures, legal requirements, and applicable regulations at all times, and take personal responsibility to read, understand, follow and keep updated with the latest versions.
• Avoid and report any actions that may cause financial loss, reputational damage, or breach of trust to the organization, including fraud, dishonesty, or misrepresentation, which may result in disciplinary action, termination, and legal liability.
• Maintain confidentiality of all organizational, patient, client, and employee information in accordance with policies and laws.