Mohammed Iyaz Hamza

RESPONSIBILITIES:
 To setup the HMS application based on the client requirements.
 Creating doctors list, duty schedule, staff list, TPA list, Insurance Payers list, Network list,
Price list, etc
 To conduct the department wise user training in the HMS application.
 To provide the user support as and when required.
 Dealing with major insurance companies in UAE especially National Health Insurance
Company - Daman.
 To oversee the submitted records for any kinds of error or duplication.
 To coordinate all programs of insurance and claim related activities.
 Supervising and overseeing the daily operations of claim submission & related activities.
 Extensive knowledge of DHA and HAAD Protocols.
 Well versed in handling E claim Submission along with PBM.
 Independently handling in house system-Upgrading/ resetting/implementation of
pricelist and mapping.
 Contracts negotiations and Network expansion
 Tariff review, analysis, comparison and negotiation

Job Responsibilities:

▪ An astute professional with over 5 years of rich experience in operations, production, product development and quality control and compliance in the garments manufacturing industry.
▪ Extensive experience in product planning production vendor development maintainance planning and execution in shifts and procurement and logistics of raw materials .
▪ Handled production like shirts, tshirts for buyers of international repute like tommy Hilfiger, jack and johns, rig, Edhardy etc.
▪ Played an integral role as the Team Leader with a track record of success in managing production of Uniform for Kerala police, Kerala Customs, Marine customs, Air force, military’s in Kerala and other government Officials with all ranks .
▪ Manage day-to-day operations, Training, managing and motivating the employees.
▪ Worked to improve overall office productivity.
▪ Coordinate with Garments vendors and timely ordering the supplies.
▪ Conducting timely meeting with higher Police officials to ensure regular orders are obtained.
▪ Ensure regular visits to the Police training camps to obtain new orders.
▪ Ensure on time delivery of the finished orders and rectifying the errors if any.
▪ Maintain updated records of daily, weekly and monthly revenues and expenses.
▪ Advise staff on the best ways to resolve issues with clients and deliver excellent customer service. ▪ Friendly relationships with customers to increase loyalty and boost reputation.

Job Responsibilities:
▪ Handling reconciliation processes within all provider networks
▪ Experience in Revenue Cycle Management (Insurance)
▪ Monthly reporting of provider payments & remittance advice
▪ Benchmark providers’ network by category
▪ Contracts negotiations and Network expansion
▪ Monitor, control and continuously update provider network directory
▪ Knowledge in Medical Coding (ICD-9, ICD-10 and CPT)
▪ Extensive knowledge of DHA and HAAD Protocols.
▪ Well versed in handling E claim Submission along with PBM .
▪ Independently handling in house system-Upgrading/ resetting/implementation of pricelist and mapping.
▪ Independently conducting provider training with regards to the system usage/ PBM/I CARE
▪ Rectifying the errors occurring in the patient service department.
▪ Handling provider relationships.
▪ Tariff review, analysis, comparison and negotiation.

Job Responsibilities:
▪ Acted as the main point of contact in handling accommodation, transportation, hotel reservation, travel arrangement and other necessary services for ambassadors, diplomats and other officials.
▪ Dealing with major insurance companies in UAE especially National Health Insurance Company - Daman.
▪ To oversee the submitted records for any kinds of error or duplication.
▪ To coordinate all programs of insurance and claim related activities.
▪ Supervising and overseeing the daily operations of claim submission & related activities.
▪ Receiving the request for approvals from different departments, medical centers and pharmacies (for Surgeries & other procedures).
▪ Reviewing the request if the condition is covered or uncovered by the insurance.
▪ Forwarding the request with required supporting documents through mail or fax to concerned insurance companies for approval.
▪ Coordinating with insurance company doctors, especially if they have any queries or clarifications regarding the request sent for approval
▪ Coordinating with the attending doctor for some clarification regarding the condition of the patient. ▪ Coordinating with the nurses whenever the insurance company needs some investigations/medical reports to be sent for the company’s perusal
▪ Justifying to the insurance company doctors with investigation and other related reports in case of re-approval or extension of admission and getting approvals
▪ Sending approved authorization request to concerned departments
▪ Maintaining log book for pending and rejected cases.
▪ Conducting insurance training class for nurses and customer relation executives
▪ Checking and finalization of Inpatient bills.
▪ Correcting XML errors, like loinc code, universal dental code, card numbers.
▪ Checking of activity code, activity type, clinician code, ICD.
▪ During the time of submission correcting card number
▪ Checking the outpatient bills and making necessary corrections with the help of customer relation executives, nurses and doctors.
▪ Updating Insurance master in ‘Hospital Management System’ software.
▪ Entering e-claims of IP, OP & Pharmacy (more than 23 insurance companies).
▪ Checking ICD-9, CPT, E&M, and HCPCS-Codes in claim forms and entering in e-claim software according to the HAAD rules and regulations.
▪ Check monthly claim forms for all requirements needed before submitting to insurance companies. (E.g. stamp and sign of doctor, signature of patient, lab and radiology reports.