Pre-Approvals Medical Center (PMC) & Inpatient Officer

Basic Function and Principles 

Answer all inquiries, identifies, segregates and registers the pre-approval requests. Maintain and file the related insurance contracts. Photocopy documents and types of correspondence. Assist in the input of data information, check of authorization, and production of reports and statistics.

Perspective    Roles and Responsibilities

Financial:-

Identify any general incorrect or missing information, application or incorrect stamps and informs the Supervisor/ Manager for action.

Customer:-

Answer all inquiries from In/Out-Patient parties regarding coverage under the specific policies and ensure compliance with them.

Receive pre-approval correspondence, documents, requests and forms. Check and segregate them.

Internal Process:-

Register the incoming correspondence and requests, as per procedures. Input the details information in the computer system.

Retrieve the related contacts, record, form and service conditions and input the information in the 

approved forms.

File, store and protect all references data and correspondence for ease of retrieval

Prepare reports and statistics.

Comply with established procedures and work instruction.

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Work Contacts

• Minimal contact internally & all the network parties                                                     

Manuals and Procedures Related to Position

• Work Procedures related to own department workflow.
• All contracts and policies signed with the various parties (hospitals, pharmacies, labs, self-insured funds)

Work Environment

• Office work, Air-conditioned environment.

Physical Effort

• Minimal Physical effort.

Work Experience

• Minimum 1-2 years of experience

Educational Qualifications

• General Practitioner Doctor (GP)

Key Performance Indicators, KPI’s

• Percentage of errors in approvals compared to the policy
• SLA of response Time
• Handling cases independently and giving approvals with minimal reference to the manager.
• Number of calls answered vs. missed calls
• Average per call handling

يرجى على الراغبين من مدينة رام الله البيرة التقدم للوظيفة من خلال البريد الالكتروني  [email protected]

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