Pharmacy Approval Officer

Full job description

A Pharmacy Approval Officer plays a crucial role in ensuring that pharmaceutical services align with healthcare regulations and insurance requirements. This position involves a combination of administrative duties, regulatory compliance, and coordination with healthcare providers and insurance companies.

Pre-Authorization Management: Review and verify pre-authorization requests for outpatient and inpatient services, ensuring they meet insurance policies and regulatory standards.

Handling Rejected Requests: Address rejected pre-authorization cases by obtaining necessary justifications from treating physicians and resubmitting to insurance companies.

Medical Coding and Documentation: Accurately code service descriptions based on medical data and ensure proper documentation for insurance claims.

Communication and Coordination: Liaise with doctors, insurance companies, and other departments to facilitate the approval process and resolve any queries.

Reporting and Compliance: Prepare daily activity reports and assist in month-end reporting to management, ensuring adherence to regulatory standards

Educational Background : Bachelor's degree in Pharmacy, Medicine, or a related medical field.

Experience : Minimum of 2 years in medical approvals, insurance coordination, or a similar role within the UAE healthcare sector.

Certifications : Medical coding certification is often preferred.

Skills : Strong understanding of insurance policies, excellent communication skills, attention to detail, and proficiency in medical terminology and coding.

 

Industries:Health, Wellness & Fitness

Function: Healthcare Administration