Experience

Accumed

• United Arab Emirates
• Hospitals and Health Care
• 200 - 300 Employee

• Pre-approval Officer

  • Jun 2017 - Present

  Enjoyed working for the pre-approval process of different clients healthcare providers such as Dubai Corporation For Ambulance Services, Sheikh Khalifa General Hospital-Ajman, Gaelan Medical Center-Sharjah, Saudi German Hospital-Sharjah. Enjoyed working for the pre-approval process of different clients healthcare providers such as Dubai Corporation For Ambulance Services, Sheikh Khalifa General Hospital-Ajman, Gaelan Medical Center-Sharjah, Saudi German Hospital-Sharjah.



IRANIAN HOSPITAL-DUBAI

• United Arab Emirates
• Hospitals and Health Care
• 300 - 400 Employee

• Medical Insurance Coordinator - Approval/Claims/Reconciliation

  • Jun 2012 - May 2017

  Process approvals of all requested services that require pre- authorization (from the insurance companies) as ordered in the ER, Out-Patient, and in the In-Patient Department. Process claim forms adjudicate for revision of deductibles, co- pays, co-insurance maximums, and provider settlements. Complete the claims, documents based on the invoice and statement of account. Make sure that all supporting documents are attached to justify the invoiced amounts, in-patient invoices should be matched with the services done, and corrections of necessary details to avoid rejections of claims. Resolved problems resulting from claim settlement by checking thoroughly details. Follows adjudication of schedule of benefits of all cardholders to make sure proper payment of claims. Prepares different monthly reports and reconciliation reports as requested by Managers. Re-submission of contested rejections should be done accordingly and would monitor if companies will pay these invoices to rectify our records correctly. On time reconciliation of paid and unpaid claims per company to make sure that all invoices are paid correctly and to clear justified rejections. Maintained our system to ensure all insurance fee schedules are current and up to date. Follow-up systematically on a daily basis all the pending requests in the system. Prepares the complete data for reconciled amounts, outstanding due payments, collectible and receivables for reporting to Managers. Worked with department staff to research, identify and provide solutions to client and insurance company inquiries. Show less