KHRISTINE DE LIMA

• Performed concurrent and retrospective utilization reviews to assess medical necessity,
appropriateness of care, and length of stay.
• Applied evidence-based clinical criteria (MCG, NCCN) to support authorization and denial
decisions.
• Reviewed clinical documentation to ensure billing accuracy, medical necessity and compliance
with payer policies.
• Verified member eligibility, benefit coverage, and network provider utilization.
• Maintained complete and audit-ready documentation in internal systems, supporting regulatory
and accreditation requirements.
• Investigated unpaid and disputed claims, ensured completeness of documentation and followed
up resolution.

• Supported members and providers with insurance inquiries, eligibility verification, and referral
coordination.
• Managed outpatient, inpatient, and off-island referrals, ensuring timely scheduling and provider
coordination.
• Issued Letters of Authorization and explained coverage details to members.
• Conducted hospital rounds to monitor patient progress and update clinical records.
• Prepared concurrent review reports for utilization management review.
• Tracked CPT codes, co-payments, co-insurance, authorized services, and estimated patient
liabilities.
• Investigated unpaid claims, ensured timely submissions, and followed up with providers and
payers.

• Managed patient registration, billing, invoicing and insurance documentation in a private
healthcare clinic.
• Coordinated physician schedules, patient appointments, and surgical bookings.
• Liaised with hospitals, consultants, and insurance providers to support patient care.
• Processed claims, reimbursements, and financial documentation with accuracy and
confidentiality.
• Maintained compliance with Qatar healthcare documentation and data confidentiality standard.