Microsoft Excel
Ammar Sharaab
Pre -Authorization Manager
Khobar
Summary
Enthusiastic Pre-Authorization eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of approval processes and training in the medical field. Motivated to learn, grow and excel in insurance business.
Overview
18
18
years of professional experience
7
7
years of post-secondary education
14
14
Certifications
2
2
Languages
Work History
Member of Medical Committee
Saudi Council of Health Insurance
Khobar
03.2022 - Current
- Developed team communications and information for meetings.
- Worked within applicable standards, policies and regulatory guidelines to promote safe working environment.
- Prepared variety of different written communications, reports and documents.
Pre -Authorization Manager
Total Care Saudi (TCS)
Khobar
12.2012 - Current
- Addresses to inquiries concerning pre-Authorization approval and medical services.
- Evaluates and assesses clinical picture and consistency of diagnosis, procedures, drug codes and descriptions stated on the Pre-Authorization requests according to accepted medical coding rules and medical guidelines.
- Reports fraud and abuse cases through medical investigation in accordance to the set of policies and procedures.
- Ensures accurate application of contractual medical service prices/ surgical/ procedure packages and discounts with the given Pre-Authorization requests.
- Contributes in developing, updating and implementing the guidelines for evaluation of medical Pre-Authorization.
- Resolves medical request by approving or denying in accordance with company"s policies as well as federal insurance regulations or The Council of Cooperative Health Insurance (CCHI).
- Processes approval of the Top Medical Insurer"s of KSA (Trade Union Cooperative Insurance and Reinsurance TUI, ACIG,AL SAGR , Buruj Cooperative Insurance, , Gulf General Insurance and Reinsurance,UCA, ASICO) request coming from authorized providers of the insured clients.
- Maintains quality costumer services by following costumer service practices; responding to costumer inquiries and respects medical and work ethics at all times.
- Dealing with international requests coming from different country and partners . Reply their inquiry and make sure they have the service
- Delivered services to customer locations within specific timeframes.
- Conducted research, gathered information from multiple sources and presented results.
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
- Collaborated with team members to achieve target results.
- Learned new skills and applied to daily tasks to improve efficiency and productivity.
Approval Officer and Auditor
Nextcare
Khobar
03.2012 - 12.2012
- Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Planned audits and audit activities to allocate necessary resources and determine consistency of plans with audit objectives.
- Interviewed business owners to understand needs and explain audit scope.
ER Officer
Al-Thaourah Hospital
Sanaa
01.2009 - 12.2012
- Provided on-site emergency treatment and responded appropriately in urgent or emergency situations.
- Performed complete histories and physical examinations.
- Demonstrated proper techniques for cardiopulmonary resuscitation and related drug therapy.
- Ordered medications and wrote prescriptions according to organizational and regulatory policies and procedures.
Branch Manager
AHTSCO Pharmaceutical Co.
Sanaa
01.2008 - 01.2012
- Boosted sales and customer loyalty through incentive programs.
- Forecasted trends and recommended improvements based on financial risk analyses.
- Complied with regulatory guidelines and requirements.
- Consulted customers to boost product sales and services.
- Gathered and reviewed customer feedback to improve operations.
- Identified partnership opportunities and established favorable business connections.
Education
Bachelor of Medicine And Surgery (MBBS) - Medicine And Surgery
Sanaa University
Sanaa 01.2001 - 01.2008
Skills
Transcription of medical notes
undefinedSoftware
Microsoft Word
Medical Insurance System
Certification
Basic Life Support (BLS), Fakhry &Al-Rajhi Hospital
Timeline
Member of Medical Committee
Saudi Council of Health Insurance
03.2022 - Current
Income in Health Cluster, Almosandah
01-2022
Anti-Money Laundering & Combating Terrorism Financing, Internatianl HRD
11-2020
Nphies: Cource COD-01 for HIC
08-2020
Leasding in Challenging Times
05-2020
Entrance to Medical Insurance, DAT
05-2020
Insurance Fraud, BIBF
04-2020
Family Medicine Striking Courses, FMhub
09-2019
ICD 10 AM, CCHI/SCHS
10-2014
Award in general insurance, BIBF/CII
09-2014
ICD10 codes (Australian modification), CI
05-2013
Pre -Authorization Manager
Total Care Saudi (TCS)
12.2012 - Current
Professional Registration ID, Saudi Commission for health Specialists, Riyadh
10-2012
Principles and practices of insurance, ITCC
09-2012
Approval Officer and Auditor
Nextcare
03.2012 - 12.2012
Basic Life Support (BLS), Fakhry &Al-Rajhi Hospital
02-2012
ER Officer
Al-Thaourah Hospital
01.2009 - 12.2012
Branch Manager
AHTSCO Pharmaceutical Co.
01.2008 - 01.2012
Bachelor of Medicine And Surgery (MBBS) - Medicine And Surgery
Sanaa University
01.2001 - 01.2008
Takaful course, BIBF/CII, Bahrain
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