Adel Ram Camba

• Collaborates with internal team i.e Payor Contracting, finance, Revenue Cycle Management and Hospital Administration to support payor initiatives and resolution efforts;
• Provides support for payor negotiation process;
• Responsible for formal dispute initiatives with managed care payors;
• Provide dedicated managed care support to other hospital departments as well as Physician Practices and Outpatient Clinics;
• Participate and coordinate organizational meetings with contract payers;
• Provide service and code-specific managed care reimbursement of payment as requested by internal departments;
• Participate in other organizational projects as assigned by Corporate Director of Payor Contracting or Chief financial Officer;
• Coordinates the timely appeal of all third-party denials and underpayments;
• Develop, write and maintain quarterly strategic and tactical plan;
• Support SEHA efforts to conduct clinical and economic trials as well as case studies and communicate those findings and our values to payors and gain contracts at desired reimbursement and payments;
• Develop and continuously perfect presentations and material for payor meetings that accurately reflects the demands of the regional territory.
• Establish and maintain strong relationships with all levels of Payor staff that impact our business. This will include clinical, non-clinical, contracting and payment;
• Coordinate with Revenue Cycle Management to follow-up with Payor accounts on payment issues and how to prevent them.

-Main task of claim denial management for the whole business entities of SEHA - SKMC, Al Rahba
Hospital, Al Ain Hospital, AHS, AGH, SEHA Dialysis Center and Corniche Hospital.
-Researches and analyzes denial data and coordinate denial recovery responsibilities.
-Facilitates optimization of revenue performance for the organization.
-Consolidates in system- CERNER enhancement and optimize revenue performance.
-Identifies, analyzes, and researches frequent root causes of denials and develops corrective action
plans for resolution of denials.
-Develop reporting tools that effectively measure and monitor processes throughout the denials
management process in order to support process improvement.
-Uses reports that categorize denials to assign tasks or personally work to overturn denials.
-Identifies and pursues opportunities for improvements in denial performance

Medical Audit process ensures that all IP/OP services have been claimed accurately from the payer to reduce rejections and recoveries. Resubmission process aims at providing the payer the justification or needed correction to enable successful payment of the previously rejected claims for payment by the payer (insurance company) at the time of
initial claim submission

Main responsibility is to process international direct billing claims from Oman, Bahrain, Kuwait, Qatar, Poland and including local. Has been awarded as one of the best claims processor of the company and being trained by Dr. Adams Barbarawi.

Performs complex chemical, biological, hematological, immunologic, microscopic, and
bacteriological tests.
* Examines blood and other body fluids and made cultures of body fluid and tissue samples, to
determine the presence of bacteria, fungi, parasites, or other microorganisms.
* Analyzes samples for chemical content or a chemical reaction and determine
concentrations of compounds such as blood glucose and cholesterol levels.
* Types and crosses match blood samples for transfusions.
* Evaluates test results, develop and modify procedures, and establish and monitor programs, to
ensure the accuracy of tests.

-Performs complex chemical, biological, hematological, immunologic, microscopic, and
bacteriological tests.
-Can use point-of-care equipment for I-STAT on electrolytes, glucometer forcapillary blood glucose
and HEMOCHRON for Activated Clotting Time.
-Analyzes samples for chemical content or a chemical reaction and determine concentrations of
compounds such as blood glucose and cholesterol levels.
-Evaluates test results, develop and modify procedures, and establish and monitor programs, to ensurethe accuracy of tests.
-A hospital staff with experience in different sections of the Clinical Pathology Laboratory working
through the standards of the Joint Commission International(JCI).