Bibhu Mishra

 Effective management of fresh claims submissions (Both IP and OP) as per the standard insurance
protocol to various network insurance companies.
 Evaluation of the Credit Invoices before submission to the Insurance Companies, reconciliation of the
denied claims with insurance companies with medical justification. Managing Resubmissions.
 Management of the high value IP cases as Case Manager, in view of maximizing revenue while adhering
to standard Coding guidelines.
 Review on the cases with treating Physicians and advise them on standard guidelines of coding and
insurance for successful approvals.
 Insurance disallowance write-offs coordinated with accounts receivables department. Regular review of
outstanding claims and minimize revenue loss to the organization.
 Maintained quality levels by conducting random charge/coding audits and working with personnel to
resolve problems.
 Managing and advising the operations department on claims with huge claimed amount, managing the
severity level of IP high value cases.
 Managed six direct reports, seven indirect reports, including financial operations team. Directed the full
lifecycle of revenue.
 Managed the successful implementation of HIS at NMCSH, AlAin, with timely training of staffs.
 Processing of the claims as per the HAAD/DHA prescribed guidelines. Training the submission staffs on
the process changes as well as case management.
 Maintaining a good relationship with all the payers (Insurance Companies) and discussing with them on
developments and changes pertaining to the payment policies.
 Key payer Management (Daman, NAS, AlDhafra, ADNIC...etc) and regularly follow up with them on the
approval and rejection trade off. Negotiation on the pricing and discounts on the high value cases and
maximize recovery.
 Preparing statistics and presentations for the management to review revenue gaps and finding claim to cost
and average claim ratio.

 Providing end to end service to key mortgage/ insurance clients. Maintain a minimal customer complaint
track record.
 Maintaining an error free work process by taking care of customer documentations and adhering to KYC
policies. Preparing customer insurance/mortgage quotation.
 Understanding client profile and advising them on insurance products leading to successful business
closures.
 As an exclusive resource, cleared the “International Wealth & Insurance Certification” by ADCB within
the first three months of joining.

 Managed key clients and their AUM portfolios as Insurance Advisor.
 Understanding of customer life stages and mortality costs involved. Effective settlement of claims.
 Giving organized presentation to corporate clients on insurance product features and specifications,
effective query handling.
 Team Handling. Managed a team of 6 skilled resources.

 House surgeon at District Headquarters Hospital, Puri, Odisha. Served in each medical wing (Medicine,
ENT, Gynecology and Pediatrics) for 4 months each.
 Acquired vast experience on instant medication on chief complaint of patients. Practiced the principles of
Preventive and Social Medicines.
 Assisted the physicians for the prognosis of disease life cycles.
 Assisted chief surgeons in abdominal surgeries. Trained vastly at Trauma care unit.
 Got trained extensively in vaccination therapy for new borne diseases and transmitted diseases for adults.
 Achieved high appreciation from all trainer physicians on successful completion of the internship and for

in district head quarter hospital, India for one year with Medicine, Surgery & ENT, Obstetrics
and Gynecology departments..
* Avert in Medical claims submissions, rejections handling, resubmissions and effective revenue cycle
management.
* Evaluation of the Credit invoices before submission to the insurance companies and reconciliations

Research analysis' and marketing strategies of APIs of Aurobindo Pharma Ltd.
 Suggested measures to minimize the GAP and level up the efficiency and profitability position of the
company as a whole. Prepared an exhaustive report on all my observations, which got high appreciations
from top officials of the company.
This operational research will help the Organization in:
 Timely achievement of Production Goals
 Decreased Cost of Production due to maximum utilization of machinery.
 Quality Assurance.
 Increased Revenue generation due to timely delivery of products..