Senior Manager
Burjeel Hospital
Total years of experience :9 years, 0 Months
January 2012 till Present
Senior Manager-Insurance &Medical claims-Burjeel Hospital
Burjeel Hospital; the largest private provider in UAE (202 beds) with world-class medical professionals, sophisticated diagnostic equipment and superior healthcare services within an extremely comforting ambience. I am responsible for the set up the Insurance and Medical claims Department within Burjeel hospital; as insurance claims are the backbone of any provider working within UAE and manage more than 30 reports including 2 Managers.Main responsibilities: - Responsible for the overall management and operation of the Department to include: tactical and strategic planning; annual budget preparation- Formulate all the Medical coding guidelines for the end-users (ICD-9, ICD 10, CPT-4, IR-DRG) according to HAAD standards & regulations
- Prepare the curriculum and Maintain continuous training program consist of 3 levels for Physicians, insurance staff, receptionist
- provide HIS training for Medical Staff- Chief member in the HIS-SAP commit to build and customize Smart insurance Module, E-claims billing system and electronic Document Management system according to HAAD rules & regulations.-Responsible for Hospital contracts with varies insurance companies as follows: • Conduct the financial and contract negotiations at the appropriate management level, in order to achieve proper factor for HAAD mandatory Tariff and DRG basic rates.• Negotiate contract terms, pricing and payment schedule, ensuring that the agreements with the insurance companies / TPA are commercially advantageous.-Manage the Daily operations, pre-approvals, claims Medical auditing before submitting them to Insurance companies.-Monitor and analysis rejections rates and denial reasons, perform claims review according to Medical Necessity and prepare the rejected claims for re submission process.
March 2011 till January 2012
Head of insurance and Medical claims department-Amrita Medical center- Consultancy services & Team Building
Main responsibilities: -Successfully manage the Insurance & claims operations of almost 20 specialty polyclinics within Amrita Medical center.
-Operationalize business strategy, initiatives, processes and procedures in order to achieve desired goals and outcomes.
-Identify and seek resolution on impediments to the implementation and achievement of business goals.
-Effectively implement and analyze the impact of Claim cost control initiatives; monitor financial results, Reduce Rejection rate; identify and implement appropriate Medical
adjustments.
- Manage claim reviews and makes recommendations based on policy provisions and processing guidelines to ensure timely and accurate claims processing and compliance with HAAD/Insurance companies' contractual standards.
-Effectively train, coach and develop insurance staff for leadership succession purposes. Evaluate, acknowledge and manage performance through the use of regularly
scheduled appraisal tools; effectively address and manage performance that does not meet required standards.
Main achievements
-Lead pricing negotiation process with insurance/TPA obtaining a 25% price increase as an average
-Reduce rejection rate from 20-25% to an average of 6% within less than 6 months.
-Amrita achieves the highest score for E&M among all the private sector providers in Abu Dhabi with accreditation for 2 years.
• SINCE MAY 2010 -March 2011
Medical Audit Manager - AccuMed healthcare Management co.
AccuMedPM is the first outsourced billing company in the Middle East, Which was founded to bridge the gap Between Medical providers and service payers.
Handling a team of Medical Auditors responsible for: -Professionally prepared (manual or electronic) and accurately coded insurance claims prompt posting of payments and reconciliation process
-Routine and persistent follow-ups on all pending claims and reimbursements
-Cash billing, corporate billing and insurance billing
-Regularly updated coding systems - ICD 9-Cm, ICD 10, HCPCS, CPT and IR DRG
-Customized monthly statistical and analytical reports and spreadsheets tracking business activity and productivity
-Real-time accounts reporting, updates of all unpaid Patient, Insurance and other third party balances
Main Achievement: - Handling Al Noor Group of Hospitals claims resubmission for 2009 with a great success (50% pay back from Daman)
SINCE OCTOBER 2007 TILL MAY 2010
Medical Authorization Supervisor at DAMAN National Health Insurance Co
Daman was formed on the 26 September, 2005 and became the UAE's first specialized National Health Insurance Company.Daman has nominated Munich Re, one of the world's leading re-insurers with an excellent reputation and over 125 years of international experience and financial strength as a strategic partner. It has since developed a renowned stretch of competencies in the health insurance industry within the region.
Main responsibilities:
Handling 2 teams (Medical team, Dental team) total of 22 staff (4 medical officers, 10 Dental officers, 4 senior coordinators, 4 coordinators)
• Responsible for the management and measurement of individual performance and team operational results on Day to Day basis, including customer service within assigned TAT, approvals and proper Rejection within Daman's beneficiary coverage and eligibility.
• Establish and implements guidelines and procedures for locals (thiqa plan) especially Dental Benfits.
• Supervises, trains and monitors skills to fullfill the tasks requirements according to operational performance indicators KPI for current staff and New Joiners.
• Reviews the quality of the authorization department approvals by documenting performances.
• Support and perform the daily task of me team (Daily productivity, Turn around the time)
• Suggests and ensures that policies & procedures are available and being followed by staff members.
• Manages score card tools, quality checking and efficiencies.
• Perform bi-annual appraisals, assign training programs, and highlight champions.
Propose two main creative innovative projects for Daman, will rock the insurance market, both under implementation.
Since May 10 2006 Till OCTOBER 2007
Medical Supervisor at Al Khazna Insurance Co.
1. Pre-authorization (Inpatient, outpatient, Dental and Medication)
2. Auditing (Direct billing, Re-imbursement)
3. Call center (Attending calls, Approvals for emergency admissions)
4. Underwriting department (discuss and finalizes declarations forms of the card holders)
Since 1 JANUARY 2006 till May 1 2006
Medical Officer at NAS Administration Giving pre-authorization for dental, out-patient, in-patient, & Medication)
Since August 2003 till now
- Working at the Egyptian Co. for Vaccines (VACSERA) Blood Bank (PLASMA SECTION)
Since April 2002 till July 2003
- Working as a Medical GP Private Hospital, Cairo, Egypt.
- Teaching anatomy & histopathology courses for 6 OCTOBER University Students.
Since March 2001 till March 2002
- Working at Al Kasr Al Ainy Hospital, Cairo, Egypt, as a Residence doctor.
Languages, Computer skills
- Arabic Language (native language)
- English Language (excellent speaking, writing and reading)
- ICDL computer license
• Master Degree (PEDIATRIC) -May 2005 Al Kasr Al Ainy, Cairo University, Egypt
• Bacillary of Internal Medicine & General Surgery - March 2001. Al Kasr Al Ainy, Cairo University, Egypt
Kasr Al Ainy school of medicine was inaugurated in 1827 as a 6-year study program in assembly of the Paris Medical School. The French doctor, Clot Bey, served as the president of the school.