Dr. Muhammad Sayeb Yaseen
Health Insurance, Medical Claims & Integrity, FWA, RCM
Summary
Pharm.D | MBA | CFE | CertCII
Seasoned claims professional with medical background having sound knowledge of end-to-end claims management process and a special grip on fraud vigilance. With seven years' worth of hands on experience in multiple aspects of Medical Insurance including team management, claims processing, fraud examination, data analysis and revenue cycle management.
Overview
7
7
years of professional experience
7
7
years of post-secondary education
3
3
Languages
Work History
Manager - Medical Approvals
Almoosa Specialist Hospital
Alahsa
01.2023 - Current
- Lead a team of 30+ Approval Officers to plan, operate, monitor and manage Medical Approvals operations covering all Insurance Companies, GOSI, MOH and Aramco handling a volume of 90,000 service per month.
- Monitored rejections and minimized over utilization and abuse by observing rejection trends from the insurance companies.
- Sourcing, Onboarded and Training new approval officers with training and new hire documentation.
- Maximized performance by monitoring daily activities and mentoring team members.
- Developed and maintained relationships with internal and external customers and roving doctors.
Specialist - Medical Approvals (IP/OP)
Almoosa Specialist Hospital
Alahsa
07.2020 - 01.2023
- Communicated pre authorization status updates with insurance companies to facilitate decision-making for patient admissions and insurance coverage.
- Followed up on rejections, medical justification, extensions and other special circumstances including contractual agreements and service codes.
- Managed, supervised, directed and trained team of 25 approval officers to smoothly run medical approval cycle for both outpatient and inpatient settings impacting total of 2000+ patient daily.
Sr. Officer - Claims Reimbursement (Team Lead)
Bupa Arabia
Khobar
09.2018 - 07.2020
- Monitored team performance, enforcing compliance with corporate claims processes and procedures while leading team of 3 officers and 3 adjudicators.
- Cultivated productive relationships with stakeholders, facilitating claims cycle.
- Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times handling 350+ claims on daily basis.
- Investigated, evaluated and adjusted health claims in accordance with Bupa Arabia standards and Medical Guidelines.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
Sr. Officer - Claims Reimbursement
Bupa Arabia
Riyadh
10.2015 - 09.2018
- Examined, analyzed, reviewed and filed claims forms and medical reports to determine insurance coverage of reimbursement claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims and coordinated with Medical Integrity team as part of Reimbursement Integrity Committee..
- Managed timely and accurate processing of 100 medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and CCHI regulations.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Education
Master of Business Administration - MBA - Business Administration And Management
Lord Ashcroft's Business School
Anglia Ruskin University - UK 01.2017 - 01.2019
Doctor of Pharmacy (Pharm.D) - Pharmacy
Government College University Faisalabad
Pakistan 08.2010 - 08.2015
Certified Fraud Examiner (CFE) -
Association of Certified Fraud Examiners (ACFE)
USA 04.2019 - 04.2019
Certificate in Insurance (CertCII) - Insurance Claims
Chartered Insurance Institute
UK 01.2020 - 01.2020
Skills
Claims adjustment
Timeline
Manager - Medical Approvals
Almoosa Specialist Hospital
01.2023 - Current
Specialist - Medical Approvals (IP/OP)
Almoosa Specialist Hospital
07.2020 - 01.2023
Certificate in Insurance (CertCII) - Insurance Claims
Chartered Insurance Institute
01.2020 - 01.2020
Certified Fraud Examiner (CFE) -
Association of Certified Fraud Examiners (ACFE)
04.2019 - 04.2019
Sr. Officer - Claims Reimbursement (Team Lead)
Bupa Arabia
09.2018 - 07.2020
Master of Business Administration - MBA - Business Administration And Management
Lord Ashcroft's Business School
01.2017 - 01.2019
Sr. Officer - Claims Reimbursement
Bupa Arabia
10.2015 - 09.2018
Doctor of Pharmacy (Pharm.D) - Pharmacy
Government College University Faisalabad
08.2010 - 08.2015
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