MEDICAL AUTHORIZATION OFFICER – INSURANCE DEPARTMENT
Al Salama Hospital
Total years of experience :15 years, 3 Months
Duties and Responsibilities as Medical Authorization Officer
• Adheres to company policy and report directly to the medical insurance director for daily tasks.
• Understands the UAE Health Regulations & Payment policies under HAAD Regulation.
• Develops complete knowledge of all the payers (insurance) accepted at Al Salama Hospital.
• Caters the insured patients
• Maintains the current contact list with payers call centre, customer service and Authorization Centre.
• Understand the basis of health insurance and basic definitions and equations.
• Regularly updates themselves with the current policies and procedures of the insurance companies as delegated by the director.
• Utilizes medical knowledge and decision making ability to the insurance practice and gives solutions for the patients and doctors of Al Salama Hospital.
• Completely adheres to the legal regulations of the authorization process and insurance practices.
• Makes legitimate communication with the insurance companies through fax, emails & telephone.
• Deals with clinical vs. insurance issues confidently.
• Acts as a relay in getting approvals for limited services for doctors and troubleshoots any issues.
• Coordinates between doctor, patient and insurers with a problem-solving attitude or as situation demands.
• Entertain queries related to policy coverage, limits and sub limits.
• Maintain good posture and attitude towards hospital stall of all departments.
• Prepares and submit daily work reports to the Director.
• Assist the Director for any improvements/ changes to be made in the processes.
• Tracks insurance details for reference.
• Attends department meetings and responds to the evaluation tests and reports.
• Maintains strict confidentiality related to agreed tariffs with different insurance companies and medical records and insurance related information of the patients.
Duties and Responsibilities as Clinic Coordinator
• Serves as a focal point for all Occupational Health clinic and office inquiries and needs.
• Register patients in the system and collects all related information required in the Hospital File Registration.
• Fix and give appointments for Different Kinds of Medical Checkup/ Health Related Requirementsfor companiesthat has contract with the hospital.
• Maintain Familiarity with the ADNOC Groups Health Related requirements and regulations.
• Coordinates with the companies’ representatives/coordinators regarding the different medical checkup concerns and any other companies’ health related requirements and needs.
• Ensuring that all the health requirement needs of the clients are properly addressed.
• Maintains familiarity with all insurance policies that the clients have.
• Follow all relevant operational procedures and instructions so that work is control out in a controlled and consisted manner.
• Maintain & develop systems to ensure the maintenance of manual and electronic filing systems and document tracking system.
• Provide a complete secretarial and administrative service to the department.
• Use a variety of software packages, such as MS Word, outlook, excel, PowerPoint and etc., to prepare presentations, records, spreadsheets, databases correspondence and documents.
• Prepare related information and reports to be submitted to the companies and for internal hospital management meetings.
• Maintain open & effective communication with the companies, hospital clients, health care providers and other employees to ensure the quality of care.
• Check and Control the work of the staff under my supervision.
• Relates well & and works collaboratively with, all levels of staff in a professional manner.
• Streamline and supervise the flow of patients in the clinic, collaborating with all the staff to ensure the provision of care to our clients.
• Observe confidentiality procedure and register and track accountable documentations to ensure security and control.
• Establish and Maintain records and filing systems.
• Adhere to Infection Control and Health and safety measures.
• Actively involving in the quality improvement activities within the Department.
• Fix appointments for the Head of the Department; keep accurate record of the same; ensure concerned people are informed in advance and necessary arrangements have been made.
• Process and dispatch Medical Check- up results for oil and gas companies, and other companies’ that has contract with the hospital.
• Maintains familiarity with the policies and regulations of health Insurances within UAE.
• Provide a complete secretarial and administrative service to the department.
• Receive and dispatch incoming and outgoing mails in the department.
• Coordinate with the departmental staff and other hospital departments for the smooth running of the daily operations on a timely manner.
• Keep the departmental records up to date and maintain its confidentiality.
• Keep track of documents in the department for easy traceability &Maintain professional confidentiality at all times.
• Ensure all arrangements for the scheduled meetings in the department.
• Adhere to Infection Control and Health and safety measures.
• Actively involving in the quality improvement activities within the Department.
• Act as a patient advocate, and orient patients on admission to room and surrounding
• Ensures patient safety and reports any incidents or unsafe practice to the staff Nurse/ Head Nurse.
• Assist in all patients’ medical concern w/ partnership with the licensed professionals.
• Assist doctors. RNs, and PNs.
• Preparing the health insurance claim forms together with all pertinent patient documents to submit to Hospital’s Insurance Department to obtain approvals from the Patient’s Insurance company.
• Coordinating insurance approval requests to Hospital’s Insurance Department to, and be the liaison between Insurance Department and patients with regards to insured procedures and services.
• Helps give instructions to patients and assist the patients.
• Complies with the policies and procedures and guidelines of the hospital.
• Perform related task that may assigned from time to time by the Auxiliary Coordinator/ Head Nurse.
Duties and Responsibilities as Customer Management Assistant / Medical Authorization Officer
• Assign at Out Patient Department Authorization Call Center of the leading Health Maintenance Organization (Health Insurance Card) in the Philippines.
• Handles telephone inquiries and provides corresponding assistance promptly.
• Facilitates the validation, verification, and Medical Authorization of out-patient consultations and diagnostic procedures and pre assessment of In- patient case.
• Accomplishes daily call log sheets from different accredited hospital all over the Philippines.
• Prepares the patient information sheet of phone in reports of hospital admissions.
• Coordinates with the Underwriting Department (URG) and Revenue Management Department (RMD) to verify the membership and payments status of member who are availing their benefits whether in patients basis.
• Receives and logs customer complaints using the specified form and tries to deliver solutions/ actions to these complaints.
• Assist internal customer to their various concerns.
• Performs related task that may assigned from time to time.