Director- Operations & Client Services
Amity Health
Total years of experience :22 years, 0 Months
Responsible for setting up, maintaining and developing the resources and infrastructure necessary for the efficient processing of pre-authorization requests and claims, contracting with healthcare providers in U.A.E and Internationally, production department including printing of cards and call centre. These processes are conducted according to the rules specified by Payers, industry norms, clinical best practice and Amity’s own philosophies.
• My job contributes to the creation of these philosophies and to put them into effect.
• The embedding of knowledge into the system and subsequent automation of these processes is a key differentiator for the company and thus I play a pivotal role in the success of the business.
• My job includes recruiting, hiring and managing a team of specialists to perform these functions, providing them with clear concise job descriptions, key performance indicators and career planning.
• Responsible for preparing an annual financial budget department in the form specified by the Finance and Administration Manager, presenting this budget to the Executive Committee.
• Function in a leadership capacity, leading associate resources, special projects/initiatives, or company/departmental planning.
• Work cross-functionally to execute company strategies.
• Serving as business unit representative on enterprise initiatives around operations processing and representing the company in industry initiatives
Provide highly strategic and tactical leadership as Deputy Medical Director of this leading company engaged in the business of Managed Care. Maintained complete autonomous decision making authority within the areas of strategic planning, new business development and diversification, operations management of Medical Claims Centre/ Medical Evaluation Unit / Network Department / Medical processing Department / Production Management (Cards) and P & L performance functions. Work directly with the Medical Director to set both strategic and operational goals and objectives. Directly supervised 65.
• Directed responsibility for achieving Revenue Budget set and agreed with the Management including profitability forecast including the preparation and implementation of annual operational plan.
• Provide the Medical Director with the organizational information it needs for its governance responsibilities. Maintain and develop the interface between the Medical Director and management. Propose and define the strategy for revenue generation to the Director.
• Present to the Medical Director tactical, operating and financial plans in line with the agreed Vision and Strategic Plan.
• Develop company’s operating objectives, and strategies in accordance with overall corporate business plan.
• Spearheaded and successfully managed to reduce Loss Ratio and successfully improved the Hospital Network which improved the average cost. Achieved and maintained profitability.
• Develop operating policies in conjunction with various functional executives and direct development and implementation of procedures required to carry-out the objectives of each.
• Ensure that the relationships between the organization and its stakeholders are open and co-operative. Support the Medical Director in its primary responsibility of strategic planning.
• Establish an organizational climate conducive to maximizing employee potential and productivity. Maintain and develop teamwork within the management staff.
• Financial analysis for the company and setting up budgets, ensuring efficient operational management of the business. Financial Analysis for all activity, improving the sales, operations profitability with expenses control and cutting cost to meet the budgeted profit.
• Track all departments’ performance and review their activity, and putting strategies with the related managers.
• Identifying new areas of opportunity for fast growth.
• Appointed as Head of Operations for setting up Health Insurance Company namely Saudi Enaya Cooperative Insurance Company in May 01, 2010
Direct daily operations and business plan implementation for the Medical Services Department of this leading company Administration of Medical Insurance / Managed Care. Full responsibility for the management of the company’s Medical Services Department and for providing full customer service support (24 x 7) including Call Centre Operations Management. Work directly with the COO to set both strategic and operational goals and objectives for the Department and Call Centre.
• Direct, supervise and coordinate the activities of 38 subordinates engaged in ensuring smooth operations of the Medical Services Department. Reporting to the COO.
• Define department goals and objectives and ensure communication to employees. Develop a working environment that supports organizational values. Prepare department budget and monitor expenditure of funds in budget.
• Design, develop and implement systems, policies and procedures in the Medical Services Department and Call Centre.
• Monitor and ensure Medical Service Department / Call Centre performance metrics are met in a timely and cost effective manner.
• Plan, develop and implement department operations management strategies aimed at enhancing image of the company and overall financial performance.
• Establish, monitor and measure Service Level Agreements in the Medical Services Department / Call Centre to significantly increase in both internal and external customer satisfaction levels.
• Provide team with guidance, motivation, and discipline to consistently achieve company’s goal & customer satisfaction. Conduct regular meetings with staff to know their feedback.
• Coordinate with the Service team to keep the Customer Service team up-dated on the latest information.
• Assign duties and shifts to subordinates and observe performance to ensure adherence to company’s policies and established operating procedures. Prepare daily work assignments roster and maintain work performance records.
• Analyzed and improved departmental operations and procedures resulting in increased productivity.
• Instituted training program to cross-train staff, improving efficiency and professionalism of entire department. Consistently received "high praise" from our customers, and even from our competitors.
• Ensure the customer service team dealt tactfully and effectively with difficult customers. Review daily activity report and report to the COO.
• Recruit, train and motivate dynamic employees for optimum operations of the Medical Services Department.
• Travel across the region to meet with clients - Insurance companies / services Providers.
• Developed and maintained positive and professional relationship with business associates.
• Actively involved in review and re-evaluation of resubmitted claims (medically & technically denied).
• Conflict Resolution - Identify, investigate and resolve customer service problems. Prepare monthly statistical reports for the information of the management.
• Check Bills for medical appropriateness, pricing, policy coverage, limits & exclusions, double billing, diagnostic services matching.
• Inspect Healthcare providers (Hospitals / Clinics) through regular visit and performed auditing of medical records, fraud detection, and evaluated quality of service provided.
• Control cost on medical claims, review treatments, conduct follow-up of in-patients, estimated length of stay, cost, policy coverage, limits & exclusions.
• Contributed to corporate growth, stability and profitability by saving company millions of dollars in potential losses through fraudulent claim detections
• Maintain strict control cost on medical claims, review treatments, and conduct follow-up of in-patients, estimated length of stay, cost, policy coverage, limits & exclusions.
• Grant approval for pre-admission approvals for Hospital admissions, surgeries, selected outpatient services like MRI, CT Scan & Minor procedures, and selected dentistry workups.
• Identify, investigate and resolve customer service problems. Prepare monthly statistical reports for the information of the management.
• Perform regular visits to Healthcare providers (Hospitals / Clinics) to inspect the quality of service being provided and carry out auditing of medical records, fraud detection, and to reaffirm business relationships.
• Interact with Insurance Company regarding policies, exclusions, schedules & updates and coordinated with Healthcare Providers.