Mohammed Al_Raey
Insurance Manger
Najran
Summary
15 years of stellar experience of medical claims with focus on maintaining company's image. Proven ability to establish professional support with clients and build strong relations with various healthcare insurance and Provider. Showcasing excellent communication, coordination, and problem-solving abilities. Reliable and target-driven, with strong time management, planning and prioritization abilities. Capable of building, training, and driving teams to achieve results.
Overview
16
16
years of professional experience
1
1
Certificate
Work History
INSURANCE MANGER
AL SHEFA SPECIALIZED HOSPITAL
Najran
04.2023 - Current
- Training new team members on company policies and procedures, including CCHI regulations
- Reviewing claims to ensure that they are accurate and complete, and approving them for payment
- Preparing reports on data related to claims processing, including claims denial rates and turnaround times for different types of claims
- Communicating with patients, physicians, insurance companies, and third-party administrators on billing issues
- Ensuring that all documentation is accurate and up to date, including patient records, insurance claims, and physician orders
- Managing and overseeing all aspects of the billing department, including hiring staff and overseeing their performance
- Ensuring timely and accurate payment of claims to providers by submitting them to insurance companies for approval
- Communicating with patients about their account status and explaining any discrepancies or denials in their bills
- Cooperating with other departments within the organization to ensure that billing operations run smoothly.
SUPERVISOR, BILLING & SUBMISSION
Dr.Soliman Fakeeh Hospital
Jeddah
11.2008 - 04.2023
- Perform as a practice expert at the department on all issues relating to billing and intake processes
- Audits of current procedures and processes, discover billing/intake operations areas to improve on
- Collaborate with other departments to get and analyze additional information about patients to be able to record and process billing effectively
- Carry out all billing activities in accordance with its overall protocol, and also that they complied with the payer requirements, regulations, and guidelines
- Remaining updated on CCHI and all other health information management issues and regulations
- Ensure automated billing systems are working properly
- Prepare reports on data related to claims processing, including claims denial rates and turnaround times for different types of claims
- Analytical and communication skills and ability to work with minimal direction
- Identifying areas for improvement and recommending solutions.
ACCOUNTANT
AHMED BHAGAT (GOLDIE)
09.2007 - 09.2008
Education
BSc - Accounting
Tanta University
Skills
Data analysisundefined
Place Of Birth
Tanta, Egypt
Personal Information
Date of Birth: 09/25/81
Accomplishments
Directed competent team to allocated workloads across functions to ensure precise and punctual task completion.
Established transparent lines of communication with senior-level management, facilitating meaningful interactions.
Spearheaded implementation of cutting-edge systems and software to streamline provision of management, operational, and financial information.
Managed tight deadlines and diverse insurance responsibilities, such as Submission claims, Denial, collection follow UP, pricing.
Participated in wide range of engagements of insurance company's contract.
Participated in wide range of engagements of final Reconciliation.
Certification
Strategies to Prevent Claims Denials (HFMA)
Timeline
Strategies to Prevent Claims Denials (HFMA)
01-2024
INSURANCE MANGER
AL SHEFA SPECIALIZED HOSPITAL
04.2023 - Current
SUPERVISOR, BILLING & SUBMISSION
Dr.Soliman Fakeeh Hospital
11.2008 - 04.2023
ACCOUNTANT
AHMED BHAGAT (GOLDIE)
09.2007 - 09.2008
BSc - Accounting
Tanta University
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