Claim auditing section head
Health
Total years of experience :2 years, 3 Months
Health care leading organization (NKH) November 2013 - present
Claim auditing section head
Job Responsibilities: - To set a clear with timeline for a monthly plan for auditing and delivering the claims.
- Follow the employee tasks, handle inquires, set meetings and coordinating with other departments.
- Daily claims either OP or IP auditing to limit the medical and administrative deduction.
- Auditing on medical files for insured cases.
- Financial and administrative claims final ensured.
- Coordinate to set the guidelines to avoid deduction and to set clear rules for patient receipt in the hospital and provide the covered service and to be provided to all responsible departments.
- Rejected claims auditing, to analysis the data and to set a justified reply to clear the issue through rules.
- Rejected claims negotiation through holding meetings with the insurance company.
- Rejection notes notifications to the responsible department for feedback and awareness for insurance guidelines and exceptions.
Medical care company (S.M.S) February 2012 - October 2013
Operation manager and Account manager
Job Responsibilities: - Managing medical care accounts, Developing, Expanding and maintaining the relationships with current clients.
- Operating medical care contract with the corporate through certifying approvals, solve problems, provide clients with solutions to their inquiries, consulting and other issues with highly medical service can be provided.
- Budget control by following software estimated and claimed documentation, reports and invoices.
- Monitoring problems of network and co-ordination with other departments.
- Chronic medication managing, setting data, updating prescriptions, following budget, contact pharmacies, reviewing and handle the all cycle through accuracy and time main inquires.
- Auditing, refunds, consumes through Abides the policies and contracts.
Auditing department: Job Responsibilities: - Auditing claims through reviewing contracts, benefits, pricing and rules either by software or manually.
- Abides the policy and procedure of auditing department.
- Auditing Claims through pricing and detecting faults based on contracts and benefits.
Marketing and sales department: Job Responsibilities: - Contact companies, Work to sell them contracts of medical services offered by S.M.S.
- Handle customer issues as well.
- Updating customer data.
- Conducting market research & Promoting new projects.
- Holding meetings
- Evaluating marketing campaigns & Monitoring competitors activity.
Developmental and social experiences:
Volunteer, HR Member at sustainable health development team (SHD)
- Participated at Workshops "The National Program against FGM" at the National council for CHILDHOOD AND MOOTHERHOOD.
- Participated at AC material preparing of Campaigns against swine flu with co-ordination of ministry of Health with also the support of USAID and John's Hopkins Uni. for Public Health through CHL Project in Egypt.
- Participated at the Organizing team at CANCER MARATHON at pyramids with SSS Kasr el Ainy.
- Participated at Program for health awareness against hepatitis B Campaigns.
Volunteer at Life makers.
- Organizing team for events " life without smoking"
Member at Union of students at Faculty of Veterinary Medicine, Team spirit model, Smart vets' model and FNG team.
- Participated at AC material preparation.
- Organizing charity events as Orphans visits, Ramadan Campaigns and garage sale.
- Organizing Lectures and conferences.
2011 graduated from Cairo University, faculty of Veterinary Medicine. Estimated: Good - Pet animal diseases and management Diploma- Faculty of Vet Medicine Cairo University.
- Preparing for Master degree in clinical pharmacology. - General Secondary Education Certificate, Grade: 96.6 %