Medical insurance Director
Al Salama hospital
مجموع سنوات الخبرة :2 years, 0 أشهر
Current Job: Medical Insurance Director at Al Salama Hospital Group - ABU DHABI (Hospital 30 Beds -One Day Surgery 12 Beds - AlMafraq Medical Centre) we are supervising (12 Staffs Authorization Department -Medical coders 20 staffs - Audit claims Staffs 5- Resubmission staffs 5 - Billing staffs 5 - Medical record staffs 4) From 23 February 2013 till Now (Member of Board Director committee-Al Salam Hospital Group).Manage & supervise all the duties & responsibilities of Insurance department: as (Team Leader),
• Coordinating with insurance companies (Negotiation) regarding price list of consultation fees and the procedures, lab investigation, radiology, operation, medication according to market prices.
•coordinating with companies regarding pre- approval, claims form of patients & payments statement and providing new CPT coded price list to insurance companies
•Claim Submission supervise and follow up with insurance companies the billing process to reported monthly to high management (turn over monthly).
•Updating staff with all health care related information according to the (HAAD).
•Resubmission of claims after segregation the rejected claims on the basis of medical (should justify from the doctors) and non-medical reasons and forwards to the concern staff for re- submission process.
•Reporting of rejections, outstanding claims.
•Coordinate with IT department for any adjustment /changes of insurance company polices.
•coordinating with attending physicians regarding pre-approvals and insurance claims, medical coding & medical auditing &the medical billing
•Guiding attending physicians regarding different requirements of insurance companies
•Guiding all the staff regarding insurance policies, and informing any new policies by insurance companies
•Supervision on insurance staff department
•Follow up & guiding insurance team about claims submissions, payments received, rejection resubmissions, final payment received.
•Continuous educating process of staff and doctors regarding insurance matter
•Negotiating terms of contract with new insurance companies
•Marketing plan with the most governmental and private companies, hotels, statistics on the numbers of inpatients and the outpatients monthly in comparison to last years.
•Studying the price list of all medical services in the other health providers and hospitals for the competition
• Follow up the auditing and reconciliation with all insurance companies
• Supervise the coders for checking the claims (OP & IP) ICD9 -CPT 4- HCPCS
• Arrange the new contract with all insurance companies
ACADEMIC QUALIFICATION • Certificate of training for successful completion of “nationalaccreditation program” for family health units and centers (16 -23 October 2005) • Certificate for registering as (junior surveyor) according to the national policy of surveyor (quality unites in faculty of medicine- Ain Shames University) • Condensed training course (training of trainee) on quality in primary health care Centers and units from (14–9 May 2005) • Condensed training course (one week) on ultrasonography on abdomen & pelvis from (24 -30 April 2001) 60 hours • Professional course in school of post-graduate medicine and health science (one month) in Exeter university ( united kingdom) on modern educational module from (3 -28 April 2000) • Professional condensed course ( training of trainee )for doctors of primary health Care in the field of family medicine and its application in ( hospital–clinic center-Health units) from (5-11 October 1998) • Condensed progressive training course (six month) on upper and lower gastric. Endoscope (March 1996-September 1996).