Ibrahim Abdulrahman Alissa
Riyadh
Summary
Highly motivated and detail-oriented Insurance & Claims Specialist with extensive experience in processing, reviewing, and managing medical insurance claims. Skilled in prior authorization, claim approvals and rejections, and policy verification, with strong knowledge of SBS codes and insurance documentation. Proficient in leveraging Nphies platform and coordinating with insurance companies to ensure accurate and timely claim processing. Adept at streamlining workflows, maintaining comprehensive records, and enhancing patient satisfaction through efficient scheduling and communication. Committed to ensuring compliance, accuracy, and operational excellence in all aspects of insurance and claims management.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Insurance & Claims Specialist
Dr. Sulaiman Al Habib - Dr. Abdulaziz Alajaji Dental Polyclinic
03.2022 - Current
- Responsible for all aspects of insurance process, including approvals, rejections and daily claims reviews while monitoring system data entry of policies.
- Review and validate invoices for monthly claims submission to ensure accuracy and compliance.
- Submit approval request to Insurance companies with all required medical documents attached, demonstrating strong knowledge of SBS codes and descriptions to secure successful approval and complete claims.
- Leveraging the Nphies platform and insurance companies to benchmark it against our system and to facilitate both internal and external communication.
- Coordinating with our treating physicians regarding clarification of rejected claims, requested medical reports and any required justifications.
- Managed patient scheduling to optimize clinic workflow and enhance patient satisfaction.
- Record and enter all insurance policies received through insurance companies websites, and reflecting it through our system with a complete checklist including coverage inclusion/exclusion.
- Maintain comprehensive documentation and records related to all received approvals/policies.
- Assisted with insurance verification processes to ensure accurate patient billing and minimize discrepancies.
Operation Rome Coordinator
Dr. Sulaiman Al Habib - Dr. Abdulaziz Alajaji Dental Polyclinic
09.2019 - 03.2022
- Coordinated patient scheduling and appointment management to optimize clinic efficiency.
- Streamlined communication between physicians and patients to improve service delivery and booking processes.
- Submitting general anesthesia (GA) approvals, ensuring all necessary medical documents were completed.
- Prepare and reviewed all approved agreements with internal department and external centers for OR room utilization.
- Entered data, generated reports, and maintained tracking documents for operational transparency.
- Reviewed all external doctors' documentation and compliance and legality before scheduling any GA cases
- Enhanced operational workflows by maintaining organized documentation systems and updating records accurately.
- Arrange and coordinate all procedures required before GA cases.
- Ensure patient completed all the required consent forms.
- Verified and ensured invoice generation after GA completion.
Education
Bachelor of Science - Public Administration
King Abdulaziz University
Jeddah, Saudi ArabiaBusiness English
British Council
Riyadh, Saudi ArabiaSkills
- Insurance claims processing & daily claim review
- Nphies platform utilization
- Insurance portal management & approval entry
- Medical policy verification & coverage assessments
- Invoice review and claim submission
- SBS coding and descriptions
- Medical documents review and reporting
- Accurate data entry & record managements
Certification
- (218) Training licensed certificate hours.
- Course Topics: IFCE, Insurance claims handling (WCA)-CII, Excel and power BI, Insurance terminology in Saudi market, Cooperative health insurance fraud, Claims of the cooperative health insurance, Insurance claims practices, Professional communication skills for the insurance sector.
- Dental Services Mapping, Revenue cycle management healthcare (RCM).
- Sources: The Financial Academy, Nawa/Selat/CHI.
Timeline
Insurance & Claims Specialist
Dr. Sulaiman Al Habib - Dr. Abdulaziz Alajaji Dental Polyclinic
03.2022 - Current
Operation Rome Coordinator
Dr. Sulaiman Al Habib - Dr. Abdulaziz Alajaji Dental Polyclinic
09.2019 - 03.2022
Bachelor of Science - Public Administration
King Abdulaziz University
Business English
British Council