Description

Job Description

Job Description:

• Work as a back line support with pharmacists to help them if they have any insurance quires.
• Follow up the rejected pre authorization requests and process on it to get approval if the request is covered by CHI policy and medically justified.
• Communicate directly with insurance companies’ doctors and delegates to gain approval for medications.
• Managing and handling the missed pre authorization requests.
• Keep updated with the new insurance companies policies and medical guidelines to apply the exceptions or additional rules in each. This will help to take fast decision and proceed the approval.
• Work with patients to help them understand their insurance coverage and answer any related queries they might have.
• Update the list of not covered medications according to CHI new rules and insurance companies’ different policies.
• Update the drug formulary classification according to updated IDF of SFDA drug list to correctly implement the new deductible policy of CHI.
• Train front line pharmacists and keep them updated about insurance details.
• Make data analysis for the rejected medications to avoid the rejection reasons in the future claims.
• Perform other professional duties requested from line manager.

Education / Professional Qualifications:

• Education Degree :Bachelor degree in pharmaceutical since.
• Years of Experience :minimum of two years’ experience in the same field