DR.Umar Muhamad

Working on following Projects under TCS:

Cigna world wide- Gossi - Arabian Sheild - Cumberland - Buruj - Acig - UCA - Sagar - Hajj and Umrah by Ministry of umrah

• Verifying insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt
• Successfully working with payers via electronic/telephonic and/or fax communications
• Responsible for verification and investigation of authorization, and referral requirements for patients
• Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review
• Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate authorization process
• Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.

• Conducts daily ward rounds to inpatients
• Performing diagnostic or therapeutic procedures to patients in the field of specialty under the supervision of senior staff (consultant/specialist)
• Carrying out on-call duties in the hospital
• Present cases at team grand round and morning meeting when required
• Attending E.R cases on on-calls
• Attending weekly brainstorming activities
• Respond promptly to the request of consultant medical staff and nursing staff to attend any patient within the hospital, and to initiate or advise on treatment as indicated
• Undertake specific medical procedures on pediatric patients within all departments in the hospital as requested by consultants, or in support of nursing and other clinical staff Sitting of intravenous cannulae and commencing intravenous infusions, Urinary catheterizations – urethral, Administration of intravenous drugs, ECG, Phlebotomy, and arterial blood gas sampling
• Check and review blood results as directed by consultant or nursing staff
• Prescribe medicines to take home in accordance with consultant instructions and/or protocol
• Comply with the hospital’s consent and confidentiality policy
• Participates in the Major Disaster Plan of the hospital, as indicated
• Participates in online system improvement activities, system control activities, and staff development activities.

• Verifying insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt
• Successfully working with payers via electronic/telephonic and/or fax communications
• Responsible for verification and investigation of authorization, and referral requirements for patients
• Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review
• Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate authorization process
• Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a tat less than 10 minutes
• Completes accurate documentation in both the Auth/Cert and Referral Shells
• Completes notification to all payers via electronic/fax/telephonic means within 24 business hours of service to ensure compliance with Managed Care contractual requirements
• Determines Medicare primacy based on CCHI guidelines
• Determines inpatient Medicare coverage for days exhausted and hospice entitlement
• Ensures timely and accurate insurance authorizations are in place prior to services being rendered
• Follows departmental policies and procedures when necessary authorization is not obtained prior to service date
• Answers provider, staff, CCHI and patient questions surrounding insurance authorization requirements
• Visit hospitals for high-value cases
• Investigate fraud and unjustified cases
• Business visits for high-cost investigation and negotiations.

• Key Outputs Prospective Insurance companies identified, agreements reviewed, the selection made and contracts awarded
• Insurance policies implemented after the agreement is signed
• Follow up and negotiations with Insurance Companies where needed to ensure approval of problematic cases
• Exhausted benefits identified in close liaison with re-submission team to ensure maximum recovery from Insurance companies
• Insurance protocols complied with at all times
• Disallowance reconciliation and mutual settlement coordinated with Insurance Companies
• Insurance disallowance write-offs coordinated with Accounts Receivables department after proper reconciliation
• Disallowance reasons evaluated, improvement areas identified and changes implemented
• Submission of Insurance department statistics on a monthly basis
• Work distribution within insurance team/coaching of insurance team members
• Management of regional operational insurance programs (property-business interruption, third-party liability) - including service agreements with brokers
• Establish, communicate and manage goals and expectations for the department and individual performance
• Plan and facilitate effective team meetings to share important customer or product knowledge resulting in improved communication and proactive resolution to customer inquiries
• Regularly review outstanding claims and liaise with the Management/Finance Department to ensure the adequacy of claim reserves
• Control and monitor the appointment of Loss Adjusters and carry out minor surveys
• Prepare all statistics required by Management including Claim cost, Average Claim Ratio
• Achieve monthly team targets in terms of claims processed
• Communicate with other department managers pertaining to issues related to claims processing and vice versa.

• Handling Surgery under the supervision of senior consultants Dressing, prescribing medication post O.R Dealing with patient’s family
• Chest tubes insertion and removal Clerking Worked well independently and on a team to solve problems
• Served as a positive and enthusiastic team player.

• Training at Anesthesia Department helping consultants during surgery observing critical cases maintaining medical reports for post-operative patients