Medical Audit Manager
Madina Dental Center
Total years of experience :15 years, 3 Months
Currently working as Medical Audit Manager since 2015 for a well-established dental center in Qatar with multiple branches within Doha.
Madina Dental Center was established in January 2002 to meet the increasing health needs of the local community and provide a superior dental service. Madina Dental Center started with a three branches and now has four branches and over 30 specialist and dentist and has established itself as a trusted address for dental care.
Key Responsibilities:-
Audit medical billing, purchase orders, medical coding accuracy and completeness
of patient records across the organization.
• Negotiate insurance contracts with insurance companies and Third party
Administrators and ensure compliance to the terms and conditions.
• Resolve conflicts and initiate legal actions in case of dispute as necessary.
• Analyze and review e-claims for accuracy, completeness and eligibility. Prepare and
maintain reports and records for processing.
• Partner with internal and external audit teams, scheduling team meetings, and
managing agendas and action items.
• Provide inter department training sessions on policy implementation and change
management.
• Overseeing the well-functioning of the medical facility, including staffing, licensing,
policy making, and quality patient care.
• Working experience of interacting with patients and physicians and effective
communication with various stake holders in the healthcare sector.
• Clinical subject expertise and sound knowledge of medical terminology and
practical clinical experience.
• Analytical skills to understand and implement the latest government regulations.
• Work diligently to ensure that needs of the clinic as well as its physicians, nurses,
and other medical professionals are met.
• Review hiring of new employees, medical licensing and renewal procedures and
coordinating CPD (professional development training) for staff according to
Ministry requirements.
• Diplomatically resolve patient or physician issues and ensure good customer
service.
• Review of clinical data, case reports and analysis of diagnosis, treatment plan and
prognosis.
• Leadership skills to properly delegate tasks and motivate a cohesive workforce.
• Well versed in evidence based medicine and use of scientific databases.
• Project management and communication skills to collaborate and strategize within a
team
• Capable of meeting deadlines and evolving project based on requirements from
various stakeholders and from analysis of available data.
• Archiving relevant documents and overview of record management system.
Swathi Dental Clinic is a private clinic in the urban area of Trivandrum, the capital city of Kerala State, owned by Dr Arun.R (M.D.S) I was assigned to the clinic as a full time dentist from Jan ’14 - Mar ’15 with the senior consultant practicing in the evening session.
2) November ‘07 - Feb’12 GP Dentist,
(4 ½ years) S.P.C.C Clinic, Jazan Plant,
Kingdom of Saudi Arabia
SPCC clinic is a multi-specialty clinic associated with The Southern Province Cement Co which caters to the medical and dental requirements to its large multinational community of workers and their families which amounts to a community of nearly 3000 people in addition to the local community. Here I was the GP dentist. In addition to the treatment of the patients, I was assigned to all the Medical and Dental insurance related matters. I am familiar with the pre-authorization and re-imbursement procedures for the treatments provided. Also we met with our insurance providers - BUPA, Middle East at Damam, K.S.A, for the resolution of a few concerns we had related to some of the demands put forwarded by BUPA.
3) November ’06 - Sep ’07 GP Dentist, Swathi Dental Clinic,
(1 Year) Poojappura, TVM,
Kerala, India.
Swathi Dental Clinic is a private clinic in the urban area of Trivandrum, the capital city of Kerala State, owned by Dr Arun.R (M.D.S) I was assigned to the clinic as a full-time Dentist with the senior consultant practicing in the evening session.
CONCEPTUAL SKILLS
•ICD & CPT Coding
•ICH-GCP, Schedule-Y
•ICMR Guidelines
•Pharmacovigilance
•IEC
•Literature reviews.
STRENGTHS
•Sound knowledge of medical terminology and practical clinical experience.
•Comprehensive problem solving ability.
•Attention to detail and time management.
•Excellent communication and interpersonal skills.
•Efficient at collaborating with people from a broad range of specialties.
•Fluent in English, Arabic and other local office languages.
•Flexibility to adapt to new technologies and zeal to learn new things.
•Eager work and deliver under very tight schedules and meet deadlines.
•Ability to work with minimal supervision in fast paced environment.
•Can work in multicultural and different global work environment.
•Deep knowledge of monitoring procedures.
•Detailed knowledge of GCP and ICH guidelines and basic understanding of regulatory requirements.
•Comprehensive knowledge of Convince S.O.P.'s for site monitoring.
•Basic knowledge of clinical trial process.
•Working experience of interacting with patients and physicians.
,