Business Center Manager
Arrazi Clinics
مجموع سنوات الخبرة :18 years, 0 أشهر
1.Management of the following Departments:
a). Marketing Department
b) Insurance & Billing Department
c)Approvals and contracts department
d) Reconciliation Department
2.Developing the plans of action and follow-up for implementation in order to submit the claims to the respective insurance companies within the set time-frame.
3.Developing the plans and supervision regarding the application of electronic claims to the respective insurance companies.
4.Overseeing the audit process and the counter auditing on all claims before these are delivered to the insurance companies which includes the following;
a.Medical Review.
b.Management Review (Ordering the invoices, checking the validity of the data and completing all the necessary required attachments).
c.Counter-checking the deductibles and discount rates as per the agreed contractual terms.
d.Counter-checking the item prices as per the approved price lists
5.Following-up with the hospital administration to complete the process of medical reports and put these on the system.
6.Implementation of training courses for the receptionists, doctors and the nursing staff in order to implement the required data correctly to the system as per the requested e-claims data.
7.Regular follow-up with the Finance Department for the collection of the settled liabilities on monthly basis.
8.Supervision of the claims cancellation or re-billing process with auditors in order to facilitate the workflow and to ensure the submission of claims properly.
9 Review and processing the insurance rejection and responsible for final settlement and clearance with the Medical Insurance Companies,
10 Collaborates with the clinicians in carrying out the medical regimen and necessary observations and actions.
11 Assist in the development, implementation and evaluation of staff education programs related to continuous quality /performance improvement.
Briefing the medical insurance policies with HIS system. Here summarizing medical insurance policy
benefits and exclusions according to the agreed terms & conditions between the Medgulf & Policy
holder.
Sending these Briefings to Health care Providers with the help of Active Fax system according to the
classification of providers & classes of the insured members
Updating all the data in system regarding policy amendments, suspension, reactivation & cancellation
of policies
Classification of providers according to contractual agreements & filing the confirmations of each &
every policy briefings from providers
Updating MCA, Policy summary, TPA notes and IMS
Data backup of activefax, HIS, IOP
Review all briefings prepared by other members in the section from all prospects (contents, format, language and
compliance to terms and conditions of the policy) and approve them before being sent;
Handle communication with providers with regard to briefing related issues
Communicate/advise all representative Section Heads in MediVisa on non-briefing related issues of the policy such as in-house clinic, special discounts from provider, special claims related conditions, etc;
Manage follow-up communication with providers and ensure complete collection of acknowledgments on each policy
Handle briefing related communication with MedGulf Policy Admin, Provider Affairs, etc
Provide the technical support regarding policy inquiries
Refer patients to higher centers if the needed services were not found in the assigned providers’ network.
Maternity referrals for pregnant insured ladies (as per maternity protocol).
Receive their complaints and requests, and reply accordingly (verbally or formally).
Notification of the policyholder in all referrals, Complaints, exceeding coverage limit and RTA cases
Clarifications needed in complicated cases..
Pass follow up cases (received by phone) to the approvals section.
Solve the F3 cases received from the call center agents.
Waseel errors and problems.
Suggest solutions for these problems in a political way (the provider and the insured member should be satisfied).
Prepare correspondence letters to the policy holder and the providers
Coordinate between Approval Doctors & Call Center
Follow up with management cases And Top VIP Cases
Helping the approvals doctor with any needed information
Reply salesmen and brokers inquiries regarding rejected cases
Coordinate & follow up between medivisa branches
Direct billing
Cash claims
Re-submission of claims
Negotiation with customer’s
Preparing stock reports
Data entry operation
Inventory maintaining
Preparing Letter to concerned Hospitals.
Active Directory, DHCP, DNS, IIS & Exchange Server 2003/07 administration and Maintenance.
Installation, configuration, monitoring, management of DHCP Server, DNS server, IIS server.
Ghosting: Installing Windows OS using image.
Hardware troubleshooting.
Windows OS installation and configuration.
Installation of Software like Oracle Server client etc.
Configuration and maintaining Wi-Fi connectivity.
Configuring mail client MS Outlook.
Troubleshooting LAN problems.
Maintained of Laptop, LCD Projectors
Configure, perform upgrades, and relocates PC hardware, Software, and print Servers and devices
Installing and configuring application software and various tools.
Installation and up-gradation of Anti-virus.
Day-to-Day support for the problems and maintenance
Installing and managing printer