Mai Mahmoud

Oversee pre-authorization and claim operations in compliance with medical and insurance
standards.
Developstrategicactionplansandcost-containmentinitiatives.
Supervise andtrainteamleaderstoensureworkflowefficiency.
Managedataanalysis, reporting, andinsurancecodingsystems(ICD-10, CPT).
Collaboratewithexternalinsurancepartnersforoperationalexcellence.
ImplementprocessautomationthroughERPandEMRsystems.

insurance policies system setups
pricing models
coding modules
Responsibility for the development, performance, governance and administration of the insurance provisions for the organisation to produce an efficient service and delivery solution, maximising efficiency, performance and best value against pre-agreed targets.
- manage the maintenance, development, performance, governance, administration and delivery of the insurance provision for the organisation to produce an efficient service and delivery solution, maximising efficiency, performance and best value against pre-agreed targets
- ensuring that the insurance team understands its duties and its role within the organisation
- responsibility to adhere to agreed criteria and budgets and plan to maximise efficiency, best value and performance

- meet your targets and those of the team and organisation as a whole

- the smooth running of the of the team and organisation as a whole

- contribute to training and development of the team and organisation as a whole

- assist Line Manager in achieving maximum customer satisfaction in accordance with organisation plans
- manage, direct and monitor insurance activities and the overall performance of the team to increase efficiency and maximise performance

- general administration of all insurance provisions including claims

- effective liaison, support and assistance with the whole of the organisation

- maintain and improve mechanisms for the provision of insurance, including surveying and measuring governance, performance, administration and outcomes and disseminate feedback to the appropriate persons/entities

- utilise systems to manage insurance functions, analysis and documentation

- direct the development of plans for insurance, including management to achieve targets

- developing plans for insurance progress

- support to all other departments with insurance related issues

- subject to agreed criteria; recruitment, training, set action and targets, appraise and manage performance, development, coaching and general support of all team members to ensure targets are met

- reporting (content and format as agreed) on a monthly basis or as otherwise required

- assist in developing plans for team activities to include strategy to achieve targets

- delegate authority and responsibility to team with supervision, accountability and review

- manage and maintain contact with internal and external clients/customers and suppliers

- set an example for team members of commitment, insurance management, administration standards, work ethics and habits and personal character

- maintain accurate records

- responsibly use resources and control expenses to meet budgetary controls

- adhere to all organisation policies and procedures

- interact and co-operate with all members of the organisation, its suppliers and customers

Directed allinsuranceactivities, ensuringpolicyadherenceandoperationalperformance.
Managed ERPsystemimplementationtoenhanceservicequalityandreduceleadtime.
Supervisedteamcompliancewithbudgetarycontrolsanddocumentationaccuracy.
Establishedpartnershipswithinsurancecompaniesforstrategiccollaboration.
Ledpricingandcodingmodulesystemsetup.
Supported seniormanagementinachievingefficiencyandcustomersatisfactiontargets.

Handled complexmedicalclaims, approvals, andpolicyreviews.
Conductedauditsandcompliancecheckswithinsuranceregulations.
Prepared detailedanalyticalandperformancereports.
Ensuredaccurateclaimdocumentationandpaymentprocessing.
Coordinatedwithinternaldepartmentsforefficientclaimsettlement.
Delivered high-qualitycustomerserviceandissueresolution.

•Manage routine daily claims administration work.
• Evaluating claims with regards to eligibility
• Coordinate work flow & meet deadlines.
• Decision on high cost and complicated cases.
• International Preauthorization.
• Attending calls and e-mails from insurance companies, clients, and providers.
• Coordinating with international providers for direct billing.
• Making suggestions to improve service.
• Increasing efficiency, minimizing errors and administration time.
skills:
Requires strong computer skills.
• Strong verbal and written communication skills.
• Show flexibility, excellent interpersonal skills. • Attention to detail and quality 
•Perform operational and transactional insurance claim activities relevant to the operations of the functional area at a high level of accuracy and efficiency. Tasks include record creation, entering, processing, checking and extracting data for approval, reporting and record archiving purposes. These tasks must be performed in accordance with agreed operating procedures.
• Provide information and guidance to internal customers on matters relating to the functional area, ensuring that information supplied is accurate, relevant and resolves the request efficiently. Enquiries may be a result of an identified issues or discrepancies, or requests for information for reporting or audit purposes.
• Maintain and update record databases, ensuring completeness, accuracy and confidentiality of records in accordance with information, communication and document control policies and security protocols.
• Make effective use of records and data management systems for the purposes of reporting. This includes data collection and analysis, report preparation in line with quality and organisational requirements, and making recommendations to inform decision making.
• Utilise technology applications and systems confidently to deliver efficient and effective service in accordance with Department policy. Applications include relevant finance systems, TRIM, MS Office and other technologies appropriate to the operations of the functional area.
• Proactively support the improvement initiatives of existing processes and systems by identifying opportunities and making recommendations to the supervisor regarding improving service delivery, transactional processes and data management.

Managed claimsprocessinganddocumentationpercompanyandlegalstandards.
EnsuredaccuracyinCPT/ICD-10codingandpre-approvalverification.
Analyzed claimtrendsandimplementedcorrectiveactions.
Participatedinauditsandrevenuecyclereviews.
Improved claimturnaroundtimethroughworkflowreengineering.
Prepared detailedfinancialandmedicalutilizationreports.

 Conduct Wide Department Retrospective utilization reviews of hospital Procedures and utilized Resources
 Prepare studies of efficiency of Utilization case related Resources
 Conduct Studies of Utilization based on International Codification System as CCHI, CPT, ICD 10
 Conduct Services Utilization Studies which was useful for Costing Analysis team, Nursing Department, Material management, Patient Accounting Unit
 Conduct case Mix Utilization Studies and packaging flat Rate Setting
 Participate in Revenue Audit Studies
 Participate in Patient Accounting Cycle development online Order entry and material tracking process
 Responsible for organization and scheduling the Committee meeting and prepare the quality forms as MOMs, Committee Achievement Reports
 Responsible for the whole documentation and Quality reports for Revenue management Unit in Dar al-shifa Hospital from December2013 till November 2014
 Data collection, Entry, validation, analysis, reporting
 Good knowledge with the insurance Process
 Good Knowledge with the insurance developmental process as case management Modules

Reviewed hospital utilization reports and analyzed efficiency of resource use.
Conducted variance analysis and compliance checks with medical policies.
Participated in quality committee reporting and revenue management reviews.
Supported audit and performance monitoring processes.
Recommended corrective measures for over-utilization.
Maintained medical documentation integrity and reporting accuracy.

Setup, calibrate., operate medical equipment
Prepare culture samples for analysis
Conduct range of tests
Performing Chemical tests
Working on hormones analyzer
Properly store samples to preserve them for further analysis
give results of the tests and analyse to doctors and patients

Performed biochemical and clinical analyses on patient samples.
Ensured quality and accuracy in laboratory testing and reporting.
Maintained laboratory safety and hygiene protocols.
Cross-matched blood samples for transfusions.
Managed specimen collection, storage, and documentation.
Provided diagnostic results and interpretation to medical staff.

Making appointment to see existing clients and potential new customers
Presenting products to clients
Presuading clients to buy your company product
Presenting products to clients
Meeting sales targets
Keeping records of sales and customers
Reporting information back to head office about customer needs

Promoted pharmaceutical products to healthcare professionals.
Built and maintained relationships with key clients and hospitals.
Achieved and exceeded sales targets.
Provided after-sales service and client support.
Reported market feedback and competitor analysis.
Delivered presentations and training sessions to clients.

Set up, operate, calibrate medical equipment
Prepare cultures of samples for analysis and place culture slides and examination with microscope or automatic analyzer
Conduct a range of tests to determine the samples chemical makeup
Give results of the tests to doctor and patients
Properly store samples to preserve them for further analysis
Cross matching blood for transfusion
Create and over see data accuracy protocols
Ensure the safety and disease prevention policies are followed and maintain patient report forms and laboratory records