Ahmed Ibrahim
Riyadh,saudi arabia
Summary
Detail-oriented and dedicated Medical Insurance Specialist with 3 years of experience in verifying insurance, processing claims, Approvals ,medical coding , RCM Adept at managing high volumes of Auditing and Approvals while ensuring accuracy, compliance, and timely resolution of issues. Seeking to leverage expertise in insurance management and RCM to contribute to the success of Project
Overview
7
7
years of professional experience
4036
4036
years of post-secondary education
1
1
Certificate
Work History
Medical Approval Associate
Accumed
Riyadh
06.2024 - 04.2025
- King Faisal specialist hospital Project
- Proficient in managing approvals for inpatient admissions, ensuring compliance with clinical and insurance guidelines for hospital stays and complex procedures. Experienced in coordinating between healthcare providers, case managers, and insurance companies to secure timely authorizations and reduce delays in patient care.
- Experienced in handling approvals for outpatient procedures, ensuring timely authorization and compliance with payer policies and medical necessity guidelines. Skilled in reviewing clinical documentation, coordinating with physicians, and communicating with insurance providers to facilitate approval for treatments, diagnostics, and therapies conducted outside of hospital admission
- Maintained KPI productivity consistently above 95%, exceeding department benchmarks for Approvals and resolution time.
- Send approval requests through insurance portal Naphis.
General Dentist
Teaching Dental Hospital
Khartoum
07.2021 - 07.2023
- Instruct patients on how to care for their mouths and teeth on their own
- Increase clients through marketing services and creative practice options
- Examine and diagnose patients via routine check-ups and tools such as x-ray machines
- Consult with patients about dental options to discuss treatment of the mouth and teeth and ensure that no treatment has commenced without taking the informed patient.
Healthcare Physician
Eve organization For Healthcare & Development
Khartoum
07.2021 - 11.2022
- Patient care, Conduct thorough examination, diagnosis medical condition, develop treatment plans
- Treatment plans, prescribe medication therapies, and lifestyle changes to improve patient health
- Patient education, Educate patients and their families about health issues, treatment options
- Collaboration, Work with other healthcare to provide comprehensive care
Intern Dentist
Khartoum dental teaching hospital
Khartoum
06.2020 - 06.2021
- Perform comprehensive oral examinations and develop personalized treatment plans for patients
- Provide a wide range of general dentistry services including fillings, extractions, root canals, crowns, bridges, and more
Medical Claim Associate
TPA
Riyadh
04.2019 - 03.2020
- Modifying and Auditing claims according to medical justification, CCHI & policy Terms & Condition
- Calculated premiums, refunds, commissions, adjustments and new reserve requirements, using insurance rate standards.
- submitted healthcare claims to ensure accuracy, compliance, and proper reimbursement.
- Inpatient knowledge of DRG,DMU,DSU validation, length of stay, discharge status codes, and high-cost procedures. Experience working with hospital stays, surgical interventions, and multidisciplinary care documentation.
- Outpatient through Proficient in reviewing claims for ambulatory procedures, emergency visits, diagnostic testing, and specialist consultations. Ensures accurate use of CPT/HCPCS codes and modifiers.
- Recognized as Top Performer in the Claim department for 95% consecutive quarters based on KPI metrics
- Analyze medical claims for accuracy and completeness
- Reviewing insurance claims for completeness and accuracy
Dental Assistant
Highcare Dental Clinic
Khartoum
07.2018 - 01.2019
- Scheduled appointments, prepare bills and receive payment for dental services, complete insurance forms and maintained records, manually, and using computer.
- Developed positive relationships with patients and colleagues.
Education
BACHELOR OF DENTAL MEDICINE & SURGERY - DENTISTRY
Ibn sina university
ASSOCIATE IN COMMUNICATION - ENGLISH
Cambridge School
04.2016
Skills
- Results-oriented
- Strong knowledge
- Communication Skills
- Team collaboration
- Technical proficiency
- Problem solving
Certification
- Sudanese medical license (SMC)
- Saudi commission for health specialties (SCFHS)
- Basic life support license
- Revenue Cycle Management Training program (RCM)
Languages
Arabic
English
Timeline
Medical Approval Associate
Accumed
06.2024 - 04.2025
General Dentist
Teaching Dental Hospital
07.2021 - 07.2023
Healthcare Physician
Eve organization For Healthcare & Development
07.2021 - 11.2022
Intern Dentist
Khartoum dental teaching hospital
06.2020 - 06.2021
Medical Claim Associate
TPA
04.2019 - 03.2020
Dental Assistant
Highcare Dental Clinic
07.2018 - 01.2019
BACHELOR OF DENTAL MEDICINE & SURGERY - DENTISTRY
Ibn sina university
ASSOCIATE IN COMMUNICATION - ENGLISH
Cambridge School
Personal Information
Date of birth: 03/11/94
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