Medical Auditor
Al GARHOUD PRIVATE HOSPITAL
Total years of experience :19 years, 1 Months
Assist physician by evaluating outpatient and inpatient cases records in accordance with clinical guidelines. For insurance patients, I help with providing medical necessity for claims and justify denied cases if any. Being part of audit team gives me an opportunity to be working closely with practicing physicians and utilize my medical knowledge and insurance practice for benefit of organization
Worked with the broker to assist clients with their claims to insurance companies. I have left the job during probation period for better opportunity
Managing high cost cases referred by preauthorization team as well as care management for high-risk cases. Manage the high cost claims referred by claims team for medical comments and advice on the medical necessity
My role was outpatient preauthorization doctor handling the request for op approvals. In addition, I was a key person and point of contact for PBM system, was involved actively in the system set-up, testing and launching
Deal with approvals for direct claims within network of providers, auditing claims, reimbursement and help line approvals (having help line mobile after working hours for average 1 week per month), then medical call center was introduced in January 2013; 24hours per day/ 7 days per week. The main duties are dealing with approvals for pharmacies, clinics and hospitals and answering queries from members, brokers and health providers.
Worked as a senior resident in the Surgery Department. Performing minor operations: wounds, burns, abscess and open appendectomies. Assisting the consultant surgeon in major surgeries.
Handel the ER patients: Life-threatening cases, trauma and emergencies.
Worked as a GP in surgery and urology
Internship at the Ministry of Health- Sudan. During this period served in different hospitals and gained the necessary skills needed as a fresh medical candidate