RASHID ABDULAAL
Khobar,04
Summary
Experienced Medical Claims Processor with a strong background in evaluating and auditing medical claims for accuracy and compliance. Skilled in identifying discrepancies, ensuring adherence to coding guidelines, and optimizing revenue cycle management. Utilizes advanced auditing software to conduct thorough reviews and collaborates effectively with healthcare providers and insurance companies. Committed to maintaining high standards of quality and integrity in all auditing activities.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Claims Processor
Total Care Saudi (TCS)
01.2023 - Current
- Achieved a high accuracy rate in claims auditing, significantly reducing denials and increasing revenue recovery.
- Streamlined the claims review process, resulting in faster audit turnaround times and enhanced client satisfaction.
- Processing Hajj/Umarh and Vist visa claims according to rules and regulations provided by MOH & CCHI.
- Developed comprehensive training programs for new auditors, leading to reduced onboarding time and improved team performance.
- Decreased claim rejections through the identification and correction of billing errors, contributing to substantial annual savings.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
General Practitioner
Dammam Medical Complex
06.2021 - 05.2022
- Kept detailed records of medical conditions and histories to provide best-in-class and individualized care.
- Monitored vital signs during treatments and adapted plans to maintain patient comfort.
- Educated patients on treatment options for various illnesses, collaborating with specialists to provide thorough education.
- Performed physical exams on patients, continuously communicating about patient needs and comfort levels.
- Collaborated with nurses to triage and prioritize patients in high-pressure situations, making rapid and effective decisions.
- Thoroughly examined patients and elicited medical history data to use in assessing health and identifying conditions.
- Interviewed patients concerning physical complaints, discussed symptoms, asked questions, and suggested treatment options.
Education
Bachelor of Medicine & Bachelor of Surgery - General Medicine
Xuzhou Medical University
Xuzhou City, Jiangsu Province, China 07.2022
Skills
- Medical Coding and Billing: Expertise in ICD-10, CPT, and HCPCS coding
- Claims Review and Analysis: Proficient in evaluating claims for accuracy and compliance
- Data Analysis: Skilled in analyzing claims data to identify trends and errors
- Attention to Detail: High accuracy in reviewing Communication Skills: Effective in preparing reports and resolving issues with stakeholders including CPR, Foreign body removal
- Problem-Solving: Capable of identifying and addressing claims discrepancies
- Customer Service: Experienced in handling inquiries and disputes professionally
- Software Proficiency: Knowledgeable in claims auditing software and EHR systems
- Organizational Skills: Ability to manage multiple audits and projects efficiently
- Ethical Judgment: Committed to maintaining confidentiality and ethical practices
- Coverage Determination
- Prior authorization processing
- Claim Amount Calculations
Certification
- Insurance Foundations Professional Exam (IFCE), 03/2023
- Cardiopulmonary Resuscitation Certificate, 02/2021 - 02/2023
- Introduction to Cybersecurity course certificate.
- Appreciation Certificate from the Saudi Central Board for Accreditation of Healthcare Institutions. (CBAHI), 2022
- Saudi Commission for Health Specialties classification certificate (SCFHS), 07/2024
- Anti-Fraud in Insurance course certificate, 02/2024
Languages
Arabic
Native language
English
Advanced
C1
Timeline
Claims Processor
Total Care Saudi (TCS)
01.2023 - Current
General Practitioner
Dammam Medical Complex
06.2021 - 05.2022
Bachelor of Medicine & Bachelor of Surgery - General Medicine
Xuzhou Medical University
Similar Profiles
Ammar SharaabAmmar Sharaab
Member of Medical Committee at Saudi Council of Health InsuranceMember of Medical Committee at Saudi Council of Health Insurance
Fady ElhadyFady Elhady
Claims Department Supervisor at TCS (Total Care Saudi)Claims Department Supervisor at TCS (Total Care Saudi)
Maryam HajwalMaryam Hajwal
MOH Project Manager at Total Care SaudiMOH Project Manager at Total Care Saudi