Medical Claim Evaluator
Saudi Enaya for Cooperative insurance
Total des années d'expérience :18 years, 2 Mois
1-ICD 10 Coding and proper diagnosis detection according to
the clinical details mentioned in each claim
2-Reimbursment claims evaluation and strict auditing of the associated documents submitted with each claim
3-Capturing of the fraud and abusing cases among clients and preparing weekly reports of these cases
4-Effective communication with various departments, network, underwriting and C.C.C
1.reimbursmen claims auditing
2.assistance in the policy issuing
3.coordinating with Globe Med Saudi (TPA) in order to achieve optimum services for WAFA clients
1.Medical approval officer
2.chronic medications preparing and monthly automatic dispensing
3.medical services mapping
4. MES managing and continuous clinical updating
Datex Omeda, part of GE Corporation
1-Provide various explanatory materials related to ICU machines like ventilators and vital signs monitors
2-Holding of many in-hospital sessions concerning these medical equipments and give full training for the whole hospital staff who are going to work on them
Modules included: Physical Pharmacy pharmaceuticals pharmacology toxicology Pathophysiology Analycal Chemistry Phytochemistry Clinical Pharmacy Medicinal chemistry