Asst.Manager-Claims Submissions & Re- Submissions
Al Garhoud Private Hospital
مجموع سنوات الخبرة :21 years, 7 أشهر
Auditing insurance claims, claim denial analysis, correct pricing, standard ICD's and CPT's codes used and identifying the cause of rejection, analyze and accept rejection as well as identifying irregularities.
Assigning staff to do resubmission of rejected claims by providing the requirements needed by the insurance companies.
Leading a team of 14 staff members under the roles for Claims submission, Denial Management & Reconciliation and Medical Audit of Insurance claims.
Coordinate with insurance companies regarding network coverage, approvals and trainings.
Coordinate with doctors related to medical record of patients & identified
causes of rejection & notified the same to the concerned departments.
Participate in developing rule engines and the billing system by providing new ideas or proposal in other to enhance Process
Involved in the Empanelment and Negotiating contracts with Insurance Companies and newly launched Clinic facilities for the Group.
Mediclinic City Hospital (May 2011 -June 2017)
Job Title: Senior Insurance Co-ordinator
Work Highlights
Supervised the Insurance department and coordinated with other departments for the smooth running of Insurance operations.
Led a team of 11 Insurance Administrators, ensuring the day to day work flows of the Department are maintained.
Identifying new Tariffs to be created and mapping of the same with the relevant codes and updating the insurance companies.
Worked closely with physicians and insurance companies for case management of long stay and chronic cases.
Developed new strategies to streamline the billing and Insurance processes, which will enhance quality of patient care and satisfaction.
Conducts Induction programmes for Newly Joined Doctors and staffs with regards to Insurance Administration and the Department functions.
Arrange Refresher Training programmes with Insurance companies for Front office staff.
Generated policies and procedures of the Department.
Reviewed, updated and modified procedures on a regular basis as per the requirement of the Department.
Responsible for reviewing the performance of staff and maintained proper disciple among staff.
Acts as Liaison with Insurance companies and the Hospital with regards to Insurance queries and requests
Actively involved in the E-claims Management integration in line with DHA.
Client Management functions oriented to patient queries and issues in relation to insurance & payments
Handled the charge of the Insurance department during the absence of the Insurance Manager
Reconciliation and processing of remittances.
Payment allocation and reconciling accounts.
Dispatch of invoices, collection follow up and preparation of statement.
Process refunds and journals.
Record and balance debtors’ cashbook.
Responsible for Billing and Audit of Inpatient Billing/Surgery postings
Responsible for accurate and timely invoices for services received.
Maintains the payment records of all patients, makes payment arrangements and collects on past due accounts
Liaise with Insurance office to follow up for Approvals
Monitors charge posting, billing, and collection operations for compliance with established policies, regulations, procedures and standards
Identifies and resolves patient billing complaints
Responsible for timely dispatch of invoices with proper documentation for payments.
Process the full cycle of purchase orders from sales enquiries up to delivery arrangement
Monitor and ensure on-time delivery schedules to customers
Attend to sales enquiries and expedite immediate / ex-stock orders
Provide customers with aftermarket support
Monitor stock level and replenish products on store.
Provide administration support to the department
In charge of the Patient Affairs Department
Coordinated with the Marketing department, promoting the hospital equipment and services, marketing of the Health Insurance programme.
Lecturer on Health Education for undergraduate medical (MBBS) students.
Administered the Community Diagnosis and Management Programme
Supervised and coordinated health surveys.
Organized various health education and medical camps.
➢ Master's Degree in Public Health Management (2001) from the Faculty of Medicine, Mahatma Gandhi University, Kerala, India.
➢ Bachelor's Degree in Science (1998), St.Aloysius College