DR THASNEEM
Summary
Medical Doctor with 8 + years of MedicalInsurance experience in Dubai and adequate supervised clinical practice, seeking to obtain a challenging Supervisory/Managerial position in Medical InsuranceClaims/ Adjudication in reputed InsuranceCompanies in UAE where I can merge my strong work ethic and organisational skills. Hard-working Supervisor with exceptional experience leading teams, delivering results and exceeding expectations. Creative and motivated leader adept at utilizing exceptional design and planning strengths to accomplish complex projects. Skilled in teaching new concepts and best practice strategies.
Overview
8
8
years of professional experience
1
1
Certification
Work history
Senior Supervisor Medical Claims
National General Insurance Company, NGI
06.2016 - Current
- Well versed with Adjudication process of highly complex insuranceclaims
- Detection of abuse/fraud and escalating it to the department concerned
- Conducting audit by claims and by clinics Wellversed with ICD,CPT Codes, DRG and
- Networking Ability to work in a multidisciplinary team To communicate effectively with Medical
- Providers, Responsible for adhering to and keeping updated with all governing authorities ( HAAD/DHA)
- Responsible for Preauthorization /Helpline, Direct Billing and Reimbursement
- Claims
- Check and screen claims(e-claims and paper claims) under strict NGI guidelines
- Negotiate with providers medical necessity and advise on correct CPT codes
- Ensure all treatment is medically necessary, no fraudulent activity is occurring and try to contain cost of treatment
- Check both approvals and policy wording and conditions to ensure treatment is covered
- Ensure all correct codes have been entered against treatment
- Audit both outpatient and inpatient claims to ensure no fraudulent activity is occurring
- Continuously enhance the preauthorization protocol
- Assess risk exposure of members in line with medical underwriting policies
- Review and assess all resubmission for designated providers
- Maintain data / reports pertaining to member information/ medical cases
- Evaluating and negotiating high cost claims with providers
- Check patient notes and diagnosis to find lower cost alternative treatments
- Maintain working professional relationship with provider to ensure NGI is able to reach an agreement
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process
- Providing approvals for Medical procedures, claims processing & denials
- Getting Empanelment a regular follow-ups
- Ensuring coverage of claims and approval papers
- Liaising with Insurance Companies, Compliance and Networking departments
- Partnering with Insurers, members and health care providers to deliver cost- effective quality care.
Medical Claims Officer
Fortune Healthcare TPA LLC
Dubai
09.2015 - 06.2016
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process
- Providing approvals for Medical procedures, claims processing & denials
- Getting Empanelment a regular follow-ups
- Ensuring coverage of claims and approval papers
- Liaising with Insurance Companies, Compliance and Networking departments
- Partnering with Insurers, members and health care providers to deliver cost- effective quality care.
Education
BAMS (BACHELOR OF AYURVEDA MEDICINE AND SURGERY) -
NANGELIL AYURVEDA COLLEGE
GENERAL MEDICINE - undefined
ANJALI AYURVEDA RESEARCH
ATTENDED 1 WEEK SEMINAR IN PANCHAKARMA IN AMRITHA HOSPITAL - undefined
NANGELIL AYURVEDA HOSPITAL & MEDICAL COLLEGE, CLINICAL PRACTICE IN GOVT
PRACTICE - undefined
MAHATMA GANDHI UNIVERSITY
2014
Skills
- Medicaleducation
- Computer Literate with sound
- Knowledgeof
- MS Office ,Healthnet,
- SmartHealth, E-claims,PBM
- (Pharmacy Benefit Management)
- COMPUTER SKILLS
- Key note presentation skills
- Outlook
- Microsoft Excel, word and Power point
- Skills
Certification
CERTIFICATION OF PROFESSIONAL CODER- AAPC (ON GOING)
Currently pursuing Certified
Professional Coder - AAPC
Commitment to continuous
Timeline
Senior Supervisor Medical Claims
National General Insurance Company, NGI
06.2016 - Current
Medical Claims Officer
Fortune Healthcare TPA LLC
09.2015 - 06.2016
BAMS (BACHELOR OF AYURVEDA MEDICINE AND SURGERY) -
NANGELIL AYURVEDA COLLEGE
GENERAL MEDICINE - undefined
ANJALI AYURVEDA RESEARCH
ATTENDED 1 WEEK SEMINAR IN PANCHAKARMA IN AMRITHA HOSPITAL - undefined
NANGELIL AYURVEDA HOSPITAL & MEDICAL COLLEGE, CLINICAL PRACTICE IN GOVT
PRACTICE - undefined
MAHATMA GANDHI UNIVERSITY
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