Medical Consultant
IMC International Medical Corps
Total des années d'expérience :22 years, 0 Mois
my consultancy assigment included finalization of the preparatory works required for the set-up of the referral system, Support in establishing the agreements with the private affiliated hospitals, Develop staffing structure and job descriptions for the staff. Collect and analyze the current data to shape project staff needs in cost-effective and efficient way, Review documents that will be used by doctors, referral officers, hospitals and donor. Identify and develop necessary documents that could facilitate and improve referrals processes.
Advise and guide to establish guidelines to manage referrals at different levels starting from initiating referrals, claiming process, and settling invoices at hospital levels, inaddition to Lead the handover process with UNHCR IPs’, and attending all relevant meetings to the referral project, beside other tasks.
UNHCR - IRD - Amman, Jordan
Medical Insurance Consultant Sep. 2019 - Apr. 2020
A short-term consultancy contract for auditing medical services provided for refugees and vulnerable areas
Reviewed and analyzed contracts between UNHCR and health or medical service providers
Audited the services provided against the contract terms and scope
Minimized the costs of medical treatments provided by 25%
Checked against pre-approval for the provided services
Gained up-to-date financial clearance from medical providers.
HAKEEM PROGRAM - Amman, Jordan
Medical Insurance Consultant Oct. 2018
A 1-month contract for facilitating electronic billing and an Electronic Health Record Solution (EHS). Provided the
themes of coding systems for medical services between medical providers & insurance companies.
Established and developed the medical department since the company was new established from one employee (my self) then under my management I have the following reporters:
Doctor ( head of pre-approval section )
Doctor (field doctor
Creating and designing forms related to the department, policy wording, pricing, benefits, exclusions and plans
•Establishing and maintaining Medical Network covering all regions of Kingdom
•Managing all sections of the medical department, underwriting, claims, pre-approval and network
•Applying the Medical Insurance Software, testing all aspects and outcome, modifying the system to the optimal level and get accurate statistical reports
•Direct contact with re-insurer regarding treaty and doing, and prepare the quarter bordereau and annual presentation.
•Establish the procedure for the Medical Insurance Department
- AGI )
•supervising and managing the underwriting and production department through being responsible for medical and technical underwriting, study of renewals, supervising the whole operation, and double checking for all outcome, i.e. new policies, endorsements, offers, etc…
•Acting network department manager with all responsibilities of this position, control pricelists, yearly book and advertisement, continuous observation of our network behaviors and their average cost.
• Assigned for applying the new medical insurance system, by putting the business requirements, meeting with developers, testing phases, and do necessary follow ups on feedback from end users for required system enhancements
at (Saudi Allied Cooperative Insurance & Reinsurance Company/SACIR), K.S.A.
•Responsible for Medical claims processing - team leader
at (MEDNET), JORDAN.
•Pre-approval for in & out of hospital treatment
•Medical claims examiner
Training Courses Provided by me:
•Conducted comprehensive training course about health insurance management for “African insurance company” Libya-Tripoli MAY 25th. TO JUNE 1st. 2007
Target: Health insurance staff in the African insurance company.
Subject: Fundamentals principles and advanced of medical insurance management, underwriting and pricing, claims management, network and pre-approval
•Conducted Work shop titled (medical insurance-concepts and application) July 2009 - three days duration; Jordanian Insurance Federation
Target: Representatives from companies and institutions within the accredited network
•Conducted a training course about health insurance
Target: Health insurance staff in the Islamic insurance company - Sudan
Subject: Fundamentals principles and advanced of medical insurance management, underwriting and pricing, claims management, network and pre-approval.
place of lecture: Jordan- for one full week
•Training course for applications of medical insurance software
Subject: applying and training for medical insurance software application including production, claims, pre-authorization, network and all related reports
Place of lecture: Jordan One week. - Full working days.
Target: Medical insurance manager and staff in a reputable insurance company - west bank
practical nursing training