Ahammed Afzal
Health Care Billing And Insurance Claims/Specialist
Jeddah
Summary
My records of professional career history and area of expertise justifies my application to be a valuable employee.Submission of Medical Approvals,Monthly Bill Submission Of Insurance CompaniesLike BUPA(DHS),TOTAL CARE SAUDI,TAWUNIYA,MEDGULF,MEDNET,GLOBMED,AXA,MALATH
Experienced Health care billing and Insurance claims/Specialist with over 4+ years of experience in Healthcare.Excellent reputation for resolving problems and improving customer satisfaction.
Overview
5
5
years of professional experience
5
5
Certifications
2
2
Languages
Work History
Health Care Billing and Insurance Claims/Specialis
Sameera Medical Center
Jeddah
10.2018 - Current
- BUPA,TAWUNIYA,ALRAJHITAKAFUL,GLOBEMED,AXA,MALATH,SAICO,GULF UNION
- Provide remote colleague educational sessions on issues identified during the audit process
- Responsible for providing billing compliance education to all physicians and advanced practice practitioners within the division
- Provide feedback of audit findings to physicians and conduct post-audit training sessions as audit results
- Supervising and processing the In-Patient approvals
- Medical and policy adjudication of admitted cases in the visited hospitals based on the medical data and investigations reports in the patient’s file and the medical discussion with the treating doctor if necessary (Approve/Reject)
- Ensuring that the correct current procedural terminology, or CPT, and international classification of disease, or ICD-9, codes are used
- Determined if reported medical claims are fraud or process error, which required looking into physical claims, batch analysis, statements review, personal visits to the provider to inspect hospital records, and placing phone calls on suspected claims Requirements As a medical claims auditor, you'll need to rely on a range of analytical, technical and interpersonal skills to successfully complete most professional tasks
- Some specific skills may include:
- The ability to match the information in medical records, such as diseases, with their proper codes
- The ability communicate patient data with other medical personnel
- The ability operate computerized coding technology
- The ability to pay strict attention to details
- The ability to follow instructions in precisely the manner in which they are laid out, Responsible for auditing or adjudicating the OP medical claims and play a role in maintaining the unit production Responsible for finalizing the claims payment with in define period of time Responsible for Health care providers profiling and focus billing trends of providers Work on claims rejection summery and assist in maintaining the quality of provider’s monthly statements Work on the claims data and assist in analyzing and reporting the abusive and fraudulent behaviors and billing from providers
- Assist in preparing the claims quality and rejections reports and help the reconciliation unit to finalize the open account and final settlement with Providers
- Support the departmental strategies & play a vital role in maintaining the Quality of Medical managements from provider’s side by giving regular feedback on claims and treatment quality
- Excellent written and verbal communication skills
- Fluent in English language
- Knowledge of automated utilization review and data analysis systems
- Knowledge of health care standards appropriate to specific claim
- Knowledge of statistics and quantitative analysis methods
- Knowledge of medical, pharmaceutical, and other health services, practices, and terminology
- Knowledge of medical reimbursement policies, procedures and standards
- Knowledge of health care billing standards and procedures.
- Submitted electronic/paper claims documentation for timely filing.
- Managed large volume of medical claims on daily basis.
ACCOUNTS STAFF
DAYA PHARMACEUTICAL
09.2017 - 09.2018
- Maintaining financial reports, records, and general ledger accounts
- Preparing journal entries, analyses, and account reconciliations and assisting with monthly close processes
- Contributing to the development and review of annual operating budgets and performance projections
- Maintaining documentation for accounts payable, purchasing, and treasury and conducting internal audits
- Performing monthly balance sheet reconciliations
- Meeting processing and reporting deadlines
- Responding to information requests, reviewing financial statements, and assisting with audits
- Ensuring compliance with GAAP
- Assisting the accounting manager as needed.
Education
Bachelor Of Business - Administration
Safa College Of Arts And Science
Higher Secondary - undefined
GVHSS
undefined
MHSS Malappuram
Skills
MS Excel, MS Word and MS PowerPoint,TallyGood Knowledge in Database Concepts, Primavera 6
DHS(DIGITAL HEALTHCARE ARABIA)
WASEEL
Life and health insurance products
Healthcare billing
Behavioral health billing and collections
Health and safety standards
Patient care and monitoring
Healthcare regulations
Acute and Rehabilitative Care
Health education and resources
Certification
Linguistic Abilities
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Health Care Billing and Insurance Claims/Specialis
Sameera Medical Center
10.2018 - Current
ACCOUNTS STAFF
DAYA PHARMACEUTICAL
09.2017 - 09.2018
Bachelor Of Business - Administration
Safa College Of Arts And Science
Higher Secondary - undefined
GVHSS
undefined
MHSS Malappuram