Pharmacy Insurance Coordinator

Role Overview

Pharmacy Insurance Coordinator at American Hospital Dubai, supporting the coordination of insurance authorizations and approvals for prescriptions and pharmacy services.

Role Purpose

Assist pharmacists with insurance issues and coordinate between internal departments, patients, and insurance companies to obtain direct approval for prescriptions and ensure compliance with insurance policies and authorization requirements.

Key Responsibilities

Insurance Coordination & Authorization

• Monitor and follow up on prior e-authorization for outpatient and inpatient services.
• Take approval for prescriptions from Outpatient Clinics.
• Send approval and follow-up for e-claim prescriptions.
• Follow up for high-cost approvals with insurance companies, physicians, and the nursing team.
• Collaborate with Revenue Cycle Management and Insurance team for necessary approvals.

Documentation & Record Keeping

• Update and document all insurance approval requests appropriately.
• Prepare home delivery medication for dispatch and maintain appropriate logs as per policy and Dubai Health Authority regulations.
• Monitor the pending list daily.

Stakeholder Communication

• Communicate with patients, physicians, nursing, and pharmacy teams regarding the status of approvals according to process.
• Respond to patient inquiries and customer relationship management requests on time.
• Coordinate with Patient Relations, Nursing, and Physicians to ensure all insurance company formalities are followed to minimize objections and delays.
• Follow up on approvals for satellite clinics and provide appropriate feedback.

Quality Assurance & Compliance

• Coordinate with appropriate personnel to ensure formalities agreed with insurance companies are followed.
• Make accurate, thorough, and appropriate work a priority.
• Identify and analyze problems, take action to resolve them, apply sound judgment, and take responsibility for resolution.

Operations & Administration

• Perform home delivery processing approvals on time.
• Handle complaints and feedback, responding to emails within 24 hours.
• Send requests for outpatients within the same day.
• Anticipate and set priorities to support department needs and follow policies and procedures.
• Conduct training for new staff members about insurance guidelines.
• Perform tasks assigned from time to time.
• Work under the supervision of the immediate manager.

Qualifications & Experience

• Diploma in Pharmacy or in a related field.
• Minimum two years of experience in the Outpatient Pharmacy field.
• Knowledge of insurance policies and protocols.
• Knowledge of insurance and eRx authorization processes.
• Knowledge of authorization requirements and other prerequisites of insurance companies.
• Knowledge of coverage of insurance companies and exclusions.