Experience

Encephalon Systems
• Pakistan
• IT Services and IT Consulting
• 1 - 100 Employee
• Chief Operating Officer

  • Feb 2023 - Present


TekSoft Solutions

• Pakistan
• Hospitals and Health Care
• 1 - 100 Employee

• Head Of Business Operations

  • Mar 2022 - Feb 2023

  • Formulate business strategy with others in the executive team. • Design policies that align with the overall strategy • Planning and executing the launch of a new operational business unit. • Oversees operational systems, processes, and infrastructure while looking for opportunities for improvement or revision • Implement efficient processes and standards • Coordinate with operations and find ways to ensure client retention • Oversee the implementation of services throughout the organization. • Manage contracts and relations with Employees, Clients, partners, and other stakeholders • Evaluate risk and lead quality assurance efforts • Oversee expenses and budgeting to help the organization optimize costs and benefits • Mentor and motivate teams to achieve productivity and engagement • Works closely with the management team to ensure all operational, administrative, and compliance functions within the firm are being properly executed in accordance with regulatory-based best practices Show less



DataQ Health Pvt. Limited

• Pakistan
• Wellness and Fitness Services
• 1 - 100 Employee

• Training and Development Specialist

  • Jun 2020 - Mar 2022

  • Conduct trainings for different Quality Measure for Clinical Managers, Care Coordinators and Care Facilitators to identify if the measures were performed according to MEDICARE and HUMANA guidelines. • Conduct Training for EMR’s & EHR’s for Clinical Managers, Care Coordinators, and Care Facilitators. • Holding complete grip on various EMR’s & EHR’s • Conduct Training for the CCM program for new and existing employee’s • Conduct Training for PCM program for new and existing employee’s • Conduct Training for TCM program for new and existing employee’s • Providing training to new PCPs and Care Coordinators on TCM, CCM, AWV and PCM programs. • Provide Training to the QA team to evaluate the performance of TCM, CCM, AWV and PCM Programs • Provide Training to the QA team to evaluate the performance of employee’s • Create Training materials such as PPT presentations, Word Documents, Flow Charts, etc. • Create Excel sheets for guidelines, daily work log, and QA reporting purposes. • Work on the software development, how we can make user friendly for the team and software should be helpful for QA. Make changes according to the MEDICARE and HUMANA Guidelines for measures. • Building up work capacity and knowledge of the team on HUMANA and MEDICARE. • Creating workflows for different programs so initially start in a smoother way and managing the workforce for new projects. • Work on CMS to gather training materials and guidelines and prepare proper excels and PPTs. • QA for each employee of each for CCM, PCM, and AWV. • Creating and managing QA Reports and evaluation of each employee. • Submitting employee’s evaluation reports to the dep Managers and conducting trainings on their weak areas. • QA for software development, my job is to check the deployments and changes that has been done are as per the business team requirements and conduct trainings to convey the new updates to the team. Show less



ABIC

• Canada
• Legal Services
• 1 - 100 Employee

• RCM Specialist

  • Feb 2021 - Mar 2021

  It was 2 months contracted job to reduce the backlog and manage and educate the team on work processes and flows. Responsibilities: • Verify the accuracy of billing data and revise any errors • Operate typing, adding, calculating, or billing software. • Prepare itemized statements, bills, and records amounts due for services rendered. • Reviewed billing edits and provided insurance providers with corrected information. • Researched and resolved incorrect payments, rejections, and other issues with outstanding accounts. • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. • Resolve complex, severe exposure claims, using high service-oriented file handling. • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. • Verify and analyze used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. • Enter claim payments, reserves, and new claims on a computer system, inputting concise yet sufficient file documentation. • Contact or interview claimants, doctors, medical specialists or employers to get additional information. • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis. • Present cases and participate in their discussion at claim committee meetings. • Report overpayments, underpayments, and other irregularities. • Communicate with reinsurance brokers to obtain information necessary for processing claims. • Prepare reports being submitted to the company’s data processing department Show less



Premier Management Company

• United States
• Business Consulting and Services
• 1 - 100 Employee

• Healthcare Quality Executive

  • Nov 2018 - May 2020

  Health care quality: • Holding complete grip on various EMR’s & EHR’s • Performing Audit for different Quality Measure for registered physicians and doctors all over Texas enrolled under different ACOs to identify if the measures were performed according to MEDICARE guide lines. • Working on EMR’s and EHR’s of multiple ACO providers to collect and extract important medical records as evidence for performed measures. • Coordinate with PBE’s (Physician Business Executive) & doctor office staff on daily basis and point out the progress and issues of doctor’s regarding their quality measures and update the record after receiving the updated information by the physician. • Working on our in house developed application ‘360 Deep Learn’ to save our audited data along with the evidences under each physicians account. • Check physician EMR to identify AWV (Annual Wellness visit) performed by doctor for current year, if not performed intimate doctor to schedule AWV for quality measures for current year. • While performing audit we need to check each and every visit falling in our measurement period in order to justify the services provided to the patients in accordance with the Medicare guide lines. GPRO PHASE: • Once the audit is completed for all the providers enrolled in our ACO’s, Medicare now collects the data patient wise on sampling basis to run an audit from their end to reimburse the providers/ACO’s according to the quality percentage set by Medicare. • Once Medicare runs the Audit, they send the sample data back to the ACO’s to re-audit (if required) and submit the data back to Medicare within their given timeline before the payments are released. MARKETING: • To find and collect ACO’s within different Counties/States and check Medicare Plans Star ratings and total members.. • To find providers, providing services by specialties and check eligibility and Total Lives for providers enrolled with Medicare. • To pile up the collected data for marketing purposes. Show less



Z-Soft

• Belgium
• IT Services and IT Consulting

• Dental Biller / Supervisor

  • Jan 2018 - Oct 2018

  • Verify accuracy of billing data And revise any errors • Operate typing, adding, calculating or billing software. • Prepare itemized statements, bills and records amounts due for services rendered. • Reviewed billing edits and provided insurance providers with corrected information. • Researched and resolved incorrect payments, rejections and other issues with outstanding accounts. • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. • Resolve complex, severe exposure claims, using high service oriented file handling. • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. • Verify and analyze used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. • Enter claim payments, reservesand new claims on computer system, inputting concise yet sufficient file documentaion. • Contact or interview claimants, doctors, medical specialists or employers to get additional information. • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis. • Present cases and participate in their discussion at claim committee meetings. • Report over payments, underpayments and other irregularities. • Communicate with reinsurance brokers to obtain information necessary for processing claims. • Prepare reports to be submitted to company’s data processing department. Show less



Renusoft (Pvt) Ltd

• IT Services and IT Consulting
• 1 - 100 Employee

• AR Executive/ Credentialing Executive

  • Jan 2016 - Dec 2017

  • Verify accuracy of billing data And revise any errors • Operate typing, adding, calculating or billing software. • Prepare itemized statements, bills and records amounts due for services rendered. • Reviewed billing edits and provided insurance providers with corrected informations. • Researched and resolved incorrect payments, rejections and other issues with outstanding accounts. • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. • Resolve complex, severe exposure claims, using high service oriented file handling. • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. • Verify and analyze used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. • Enter claim payments, reservesand new claims on computer system, inputting concise yet sufficient file documentaion. • Contact or interview claimants, doctors, medical specialists or employers to get additional information. • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis. • Present cases and participate in their discussion at claim committee meetings. • Report overpayments, underpayments and other irregularities. • Communicate with reinsurance brokers to obtain information necessary for processing claims. • Prepare reports to be submitted to company’s data processing department. • Helped provider with insurances enrollment and worked as a Credentialing Executive. • Enrolled providers on CAQH, and having knowledge about CAQH. • Capable of enrolling Practices and Doctors with insurance. Show less



Sybrid Private Limited - A Lakson Group of Company

• Medical Billing Specialist

  • Jan 2017 - Feb 2017

  • Resolve complex, severe exposure claims, using high service oriented file handling. • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. • Verify and analyze used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis. Show less



Callza Communique

• Pakistan
• Advertising Services
• 1 - 100 Employee

• International Sales Representative

  • Sep 2015 - Dec 2015

  Working on targets, Data entry of leads, Web searching for clients, handle Outbound clients, B to B sales. Working on targets, Data entry of leads, Web searching for clients, handle Outbound clients, B to B sales.


Globalcom Solutions, Inc.
• IT Services and IT Consulting
• 1 - 100 Employee
• International Sales Executive

  • May 2015 - Sep 2015


Xpertz Solutions

• Pakistan
• Outsourcing and Offshoring Consulting
• 1 - 100 Employee

• Sales Team Lead

  • Jan 2014 - May 2015

  Achieving targets easily, handling team, data entry, Client handling, Sales Closing, Check attendance of team. Achieving targets easily, handling team, data entry, Client handling, Sales Closing, Check attendance of team.