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Click here or scroll down to respond to this candidateDr. Candidate's Name , M.D.
Street Address Stengel Loop Apt 102
Wesley Chapel, FL Street Address
EMAIL AVAILABLE
Mobile PHONE NUMBER AVAILABLE
Suitability
 Strong Leadership, Interpersonal & Communication Skills
 International experience as team leader in healthcare management
 Meets minimum required qualifications and experience
 Excellent skills in medical terminology verbal, written, and analytical.
 Over fifteen years of directing and managing progress and process of healthcare insurance claims in insurance companies providers.
 Handling many responsibilities and tasks in the field of healthcare insurance providers
 Over three years of Assistant physician and surgeon in the operation room, including follow up all post-surgery patients.
Qualifications & Professional Development:
o CPC certificate (medical coding) USA, Sept 2016.
o AINS 21 SEGMENT A &B examination, USA 2015.
o CII Certificate (chartered insurance institute-London) 2015.
o IFCE CERTIFICATE (Insurance foundation certificate). The Saudi Arabian Monetary Agency & the Institute Of Banking, KSA March 2011.
EDUCATION
Medical Faculty Graduate:
M. B. B. S. (Bachelor of Medicine & Bachelor of Surgery) Karachi University - Karachi, Pakistan - March 1993.
Advanced Courses:
Advanced Trauma Life Support course as a Provider According to the standard established by the American College of Surgeons in King Fahad Hospital.KSA-Jun 1999
Advanced Course in B.C.L.C (Basic Cardiac Life Support) including Cardiac Monitor on Patient on how to use Cardiac Shock with Saudi Heart Association in Affiliation with American Heart Association in King Faisal Hospital in Riyadh.KSA- Jun 1999
Compliance Awareness Training Course Certificate Dec 2011.
Anti-money laundering & combating financing of terrorism Training Course Certificate 2014.
AMCO. Essential Selling Skills Training. 30th, 31st October and 1st, 2nd November 1995.
WORK EXPERIENCE
Medical Department Manager
Salama Cooperative Health Insurance Company (SALAMA), Jeddah, KSA July 2014 - July 2016
Medical Claims Manager
Salama Cooperative Health Insurance Company (SALAMA), Jeddah, KSA July 2011 - July 2014
Medical Claims Manager
Arabian Shield Cooperative Health Insurance Company, Jeddah, KSA July 2010 - Jun 2011
Medical Claims and Operation Manager
Medical Expense Management Company (Med-X), Jeddah, KSA July. 2004 - Jan 2010
Medical Claims and Preauthorization Department Officer
Medi Visa (TPA) Member of Medgulf Group. Jeddah, KSA April 2002 - Jun2004
Medical Claims and Preauthorization Department Officer
Saudi Allied Cooperative Insurance & Reinsurance (SACIR) Jeddah-KSA Jan 2001- Nov 2002
My Primary duties and responsibilities: are managing and controlling all matters related to claims in Accordance with laid down standards and procedures, and within the predefined Limits of authority.
Maintain and develop relationships with medical providers including hospitals and clinics.
Insure efficient operational communication and coordination between medical providers, clients and the insurance company.
Provide local expertise on benefits and interpretation of policy wording and to provide advice and training to staff as appropriate.
Assist in the development of procedure pricing, capitation contracts.
Monitor medical provider costs to ensure that expenses are consistent with Agreements and to ensure that no unnecessary medical expenses are incurred.
Review all complicated and big claims as per terms, rules and regulation, and Provider price list and package deal prices.
Ensure that the pre-authorization requests are replied properly by all claims Officers.
Ensure auditing of claims (E-Claims) received from providers on FIFO system (first in first Out) & as per policy terms, exclusions and providers prices.
Conducts research regarding coordination of benefits issues, fraud and abuse, and third party liability.
Assists with the preparation of materials for audits (including Quality, Compliance, and Regulatory audits) and provides assistance to Lead and Supervisor during audit.
Proactively works to ensure claim review is resolved appropriately.
Knowledge of various payment methodologies & government reimbursement guidelines.
Knowledge of claims categorization / codification guidelines (Revenue Codes, Occurrence & Condition codes, (ICD9 and ICD10 Diagnosis & Procedure Codes).
Related Experience Field: Medical Claims Experience.
Excellent working knowledge of ICD-9, ICD-10, and Medical Terminology.
Full responsibility to follow up on all preapproval requests outpatient and inpatient,
Harmonious interpersonal relations with fellow physicians and other healthcare professionals.
Ability to organize and prioritize workload effectively
Assisted consultants and other medical practitioners with surgical interventions and procedures
Good experience in helping the general surgery.
Expert in maintaining the daily report of patients.
Dealing with patient complaints about the quality of service of the practice.
Able to lead, motivate staff and prioritize workloads during busy periods.
Controlling multiple projects at the same time.
Dealing sympathetically with sensitive circumstances.
Worked in a pressurized environment and produce the best result.
To keep a check on patients medical records for any further testing and diagnosis required.
Providing special care for serious patients assigned and conducting physical examinations and evaluating treatments on a regular basis.
Conducting diagnosis to patients who have undergone surgeries to ensure the treatment necessary is being conducted and to advice further on the patient's condition.
General Practitioner Doctor at:
Dallah Hospital, Riyadh July 1996 Nov 1999
Surgical Resident: Assistant physicians and surgeons in the operation room, including follow up with all post-surgery patients. My duties were as follow:
Coordinating with patients regarding their conditions to explain how surgeries will help them improve their life.
Reviewing records and planning treatment options.
Meeting with patients for specialized testing.
Ensuring all supporting personnel prepare for the surgery and are notified for the same.
Meeting patients after surgery to monitor recovery.
Assisted in the operating theaters in surgical operations.
Languages: English Arabic Urdo.
Hobbies: Swimming, Reading, Fishing.
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