Senior Business Analyst & Dental Benefits Management Officer
GlobeMed Group
Total des années d'expérience :15 years, 9 Mois
- Project management roles for major corporate projects (Projects are not limited to dental- across the spectrum including coding, billing, software development and roll-out, etc.)
- Business need analysis and documentation for business process cycles across the organization.
- Support change management initiatives.
- Subject matter expert for dental benefits management for all GlobeMed Operations.
- Coding guidance for Dental ICD & procedural coding systems- American, WHO and Australian coding systems (ICD-10 AM, ICD-10 CM, ICD-10 WHO).
- Develop customized dental expert system rules for automated claims adjudication in compliance with requirements of respective operations.
- Frame evidence based medical guidelines and coverage policy bulletins.
- Chief role in drafting and updating corporate manuals for the dental department.
- Responsible for corporate dental awareness pamphlets and announcements for internal and social media platforms.
- In charge of corporate dental training materials and workshops.
- Analyze and review any issues or errors related to coding, claims adjudication system and automation rules.
- Provide expert opinion on dental policy interpretation and implementation across operations.
- Liaise between different operations across Middle East for new corporate or government policies.
-Promoted as senior business analyst to provide work direction or act as team lead on designated projects or assignments.
-Define and document customer business functions and processes.
-Consult functional unit management and personnel to identify, define and document business needs and objectives, current operational procedures, problems, input and output requirements, and system/ process requirements.
-Act as a liaison between departmental end-users, information technology analysts, policy makers, governmental organizations in the analysis, design, configuration, testing and maintenance of management systems to ensure optimal operational performance.
-Analyze policy compliance, feasibility of, and develop requirements for, new and enhancements to existing systems/processes; ensure the system design fits the needs of the users.
-Track and fully document changes for functional and business specifications; write detailed universally understood procedures for permanent records and for use in training.
-Identify opportunities for improving business processes through information systems and/or non-system driver changes; assist in the preparation of proposals to develop new systems and/or operational changes.
-Plan, organize and conduct business process improvement projects.
-Recommend solutions in consultation with impacted internal and external stakeholders, objective and independent of the specific stakeholders.
-Consolidate information into cohesive and understandable correspondence for use in management decision-making.
-Assist in developing overall change management strategy.
-Conduct change impact analysis to assess the potential implications of changes and document business rules, functions and requirements.
-Participate in user acceptance testing and testing of new system functionality.
-Provide technical assistance in training, mentoring, and coaching professional and technical staff. Develop training curriculum and conduct formal training sessions.
-Frame evidence based medical guidelines and coverage policy bulletins for the social health care insurance scheme following regulatory approval.
-Attend Medical board meetings with clients, providers and regulatory authorities instrumental to policy implications, recommendations and modifications.
-Develop business expert system rules for health care information system to auto-adjudicate medical/dental claims in compliance with the policy/regulatory requirements and evidence based medical approach.
-Identify compliance discrepancies between healthcare policy & regulatory documents and escalation to regulators.
-Review prior approval requests against policy terms and conditions, financial limits and validated in the claims management system.
-Analyze and review e-claims for accuracy, completeness and eligibility. Prepare and maintain reports and records for processing.
-Data analysis and reporting.
-Lead role in updating medical department process manuals.
-Provide inter department training sessions on policy implementation and change management.
-Partnering with internal and external audit teams, scheduling team meetings, and managing agendas and action items.
-Coordination and presentations at national level health care provider conferences.
Examining teeth and diagnosing patients' dental conditions by using diagnostic tools.
-Analyze and evaluate dental needs to determine changes and trends in patterns of dental disease.
-Assessing treatment options and agreeing treatment plans with patients.
-Perform oral treatments including root canals, extractions, and fixing and removing prosthetics.
-Work with clinical staffs to provide quality patient treatments.
-Evaluate patient’s dental health and prescribe medications.
-Refer patients to appropriate specialists when needed.
-Educating patients on oral healthcare and preventive dental care.
-Stay abreast with latest developments and techniques in dental field.
-Manage business, supervising staff and handling paperwork.
-Work with office staffs in managing patient appointments and scheduling to achieve productivity goals.
-Responsible for overseeing completion of case report forms by students and clinical data entry according to requirements of the institution.
-Active involvement in patient diagnosis, formulating treatment plan and subsequent allocation to respective specialist departments.
-Overseeing the patient revisits and documenting progress of treatment plans and patient dental health condition.