Assistant Manager in Managed Care Department Health in Met Life Alico Company Karachi
Metlife Alico
Total years of experience :8 years, 1 Months
• February 2012 till present at Metlife Alico, working as Assistant Manager in Managed Care Department Health in Met Life Alico Company Karachi.
Job Responsibilities: o Accurately evaluate, regulate, and pass judgment of Medicare claims in a timely manner
o Research and take action in response to telephone and written inquires
o Enter and check over claims into system
o Send system generated letters to providers.
o Created authorizations when essential based on individual supplier and carrier contracts.
o Reviewed electronic claims and processes data as required into the claims system, resolved computer generated correct conditions, and determined right payment
o Researched and practice claim payment adjustments resulting from consumer service referrals, audited data incorrectness as detected.
o Exercised excellent judgment, interpreted medical claim data and contracts
o Processes responses accordingly.
o Achieved joint effort, production and value standards so as to guarantee timely, well-organized and accurate claim processing.
o Effectively manage preferred providers on panel.
o Case management of insured from admission till discharge.
• May 2010 till January 2012 at Darul Sehat Hospital, as Sr. Registrar ER.
Job Responsibilities: o A highly personable, competent & team spirited ER physician recognized for excelling in fast track, high stress environments able to put pateints as ease & establish subtle & often difficult to make diagnosis. A patient advocate known for working closely with hospital staff & administration in enforcing all policies & procedures & exceeding regulatory compliance standards - local, state & federal.
• April 2011 till January 2012 at AKUH, as supervisor pediatric research methodology department.
Job Responsibilities: o A common goal to enhance the health and well-being of children and families through collaborative medical care, education of professionals dedicated to pediatric healthcare, breakthrough research that improves lives, leadership and community service.
o As Pediatric Research medical officer We publishes original papers, invited reviews, and commentaries, interviews with parents & on the etiologies of diseases of children and disorders of development, extending from molecular biology to epidemiology. Use of model organisms and in vitro techniques relevant to developmental biology and medicine are acceptable, as are translational human studies.
• Jan 2006- April 2009 at Goleki Gujrat, as Senior Medical Officer, In-charge Basic Health Unit Punjab.
Job Responsibilities: o Superior diagnostic skills & treatment planning & execution proficiency.
o Outstanding bedside manner - strong interpersonal & relationship building skills.
o A team player - work in harmony with medical staff, administration, patient & family members to ensure quality medical attention consistent with organizational standard operating procedures.
• Jan 2005-Dec 2005 at Ittefaq Hospital (Trust) Lahore, as Medical Officer & DCPS trainee in Pediatric department.
Job Responsibilities: o Effective troubleshooting & problem solving skills in high pressure (life/death) environments.
o Clinically sound incorporating good decision making skills, no payment of any kind as a result of legal action.
• Oct 2004-Dec 2004 at Fatima Memorial Hospital Lahore as Senior House Officer
Job Responsibilities: o Monitor and provide general care towards in and outpatients.
o Admit patients who need treatment, investigations and special care.
o Examine and converse with patients to identify their medical situations.
o Make notes like legal treatment records for benefit of several health-care professionals.
o Work with the other doctors or within several other specialities.
o Undertaking manager responsibilities like planning workload, staffing of department especially the ones at higher levels.
o Liaising with other non-medical and medical staff in hospital ensuring quality treatment is provided.
o Promoting education about health.
o Responsible for offering methodical care to patients both in ward and in out-patient clinics by using appropriate devices like blood-pressure monitors and stethoscopes.
o Need to be specific and clear while explaining complicated procedures or conditions to someone who is not from medical background.
SPECIAL ASSIGNMENTS: • Instruction of BLS programs to the community and healthcare professionals
• Answers student questions in a competent and effective manner
• Performs and rates student practical skills evaluations
• Administers and grades written examinations
• Ensures the reporting of grades (pass/fail) to the training center
• Ensures instructor evaluations are returned to the training center
• Makes and or implements applicable suggestions on how to improve the service
• Demonstrate the correct way to use exercise equipment
• Monitor the misuse of equipment
• Deliver exercise classes and workshops & develop personal diet plans.
• 2011- Till date: EMBA in Health Service Management from Dow University Karachi. • 2005-2007: DCPS in Pediatrics' in Ittefaq Hospital - Lahore.
• 1996-2001: M.B.B.S from Liaquat University of Medical Health and Sciences
• 1994-1996: High School Diploma, from Cadet College Petaro.