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 form.

• File, store and protect all references data and correspondence for ease of retrieval
• .Prepare reports and statistics.

Comply with established procedures and work instruction.

Learning and Growth

Attend skills development programs

Share all types of knowledge with different team members.

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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)

Competencies and Skills

Competency                                                                                                     Proficiency level

                                                                                                               (High, Medium, Low, NA)

Managing Self

Ability to learn and apply knowledge                                                                 High

Detail Orientation                                                                                               High

Initiative                                                                                                              Low

Stress Tolerance                                                                                                  High

Creativity                                                                                                            Low

Research Skills                                                                                                   N/A

Computer Literacy                                                                                            Medium

English Language (oral and written)                                                                Medium

Working with Others

Customer Orientation                                                                                        High

Communication Skills: Written                                                                         High

Communication Skills: Oral                                                                              High

Communication Skills: Telephone Skills                                                          High

Communication Skills: Formal Presentations and Documentation                  Low

Handling Difficult People and Situations                                                         High

Achieving Results

Planning and organizing                                                                                  Low

Problem Solving and Decision Making                                                          Medium

Control and Follow up : Reporting                                                                 N/A

Control and Follow up : Deadlines                                                                 N/A

Negotiation and Persuasiveness                                                                     Medium

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 منطقة رام الله البيرة التقدم للوظيفة من خلال البريد الالكتروني  [email protected]