Dr.Qurat-ul-ain Sajjad

A patient advocate and liaison, assessing needs, developing care plans, and coordinating services to improve health outcomes and reduce costs . Key responsibilities include creating discharge plans, monitoring patient progress, educating families, and managing resources within hospital or outpatient settings.

Key Responsibilities for Resume:

• Assessment & Care Planning: Conduct comprehensive assessments to identify patient medical, psychosocial, and therapeutic needs, developing individualized care plans.
• Coordination of Care: Facilitate care transitions between hospital and home or other facilities, including discharge planning and scheduling follow-ups.
• Advocacy & Education: Educate patients and families on treatment options, clinical status, and community resources to improve adherence and understanding.
• Case Monitoring & Evaluation: Monitor patient progress, evaluate treatment effectiveness, and adjust care plans to achieve optimal outcomes.
• Documentation & Compliance: Maintain accurate, detailed records in Electronic Medical Record (EMR) systems, ensuring compliance with legal and organizational standards.
• Utilization Management: Evaluate the appropriateness of treatments and services to manage costs and ensure efficient resource utilization.
• Updated patient files regularly maintaining accurate records at all times.
• Collaborated closely with social workers; provided holistic care for clients.
• Drafted detailed case reports documenting all interactions and interventions with clients.
• Connected clients to community resources, enhancing their quality of life.
• Handled high-stress situations with calm, ensuring client safety.
• Liaised effectively with other professionals such as doctors, nurses and therapists in order to provide coordinated service delivery.
• Coordinated with multidisciplinary teams, providing comprehensive client support.
• Maintained confidential case documentation in line with data protection regulations.
• Built positive, productive client relationships for enhanced social support.
• Responded proactively to changing circumstances for optimized service user care.
• Consulted with multidisciplinary team of professionals to optimize treatment plans for complex cases.

• Authorization Management: Evaluated prior approval requests and managed pre-authorizations from insurance providers, securing timely approvals for services.
• Medical Necessity Review: Assessed patient documentation and clinical data to confirm medical necessity for procedures, surgeries, and treatments.
• TPA/Insurance Liaison: Coordinated directly with TPAs (Third Party Administrators) and insurance companies to facilitate authorization TAT (Turnaround Time) management.
• Case Management: Handled high-cost claim submissions, forwarding cases for second-level approval as required by policy.
• Discrepancy Resolution: Verified insurance coverage and resolved data inconsistencies, claims, and approval rejections proactively.
• Coding Accuracy: Accurately coded service descriptions on prior authorization requests to ensure accuracy and reduce approval delays.
• Patient Support: Assisted patients and healthcare providers in navigating insurance coverage complexities, providing clear guidance on policy benefits

Medical Claims Processing, Adjudication, ICD-10 & CPT Coding, Compliance with DOH, DHA MOH guidelines, Provider Network Management, Fraud Identification.

Role in Daman

Medical Review Officer (2016-2020)

Senior Review Officer (2020-2022)

Team Lead (2022-2023)

• Started off as a medical review officer, promoted to Senior Medical Review officer and then to Team lead Submission and Resubmission and Audit of AUH, DXB and NE claims
• Report Fraud and Abuse
• Escalate trends and patterns of different providers related to coding or billing errors
• Contribute to developing, updating and implementing guidelines for evaluation and processing
• Ensure Business decisions to be taken and communicated in a timely and professional manner
• Certified Medical Claims Officer with 10+ years of experience in high-volume, fast-paced insurance environments. Proven ability to adjudicate complex claims, reducing denials through rigorous accuracy checks and thorough knowledge of ICD-10 and CPT coding.
• Detail-oriented Professional specializing in healthcare claims processing and provider relations. Proficient in ensuring compliance with regulatory standards , while providing exceptional customer service to policyholders.

Clinical rotation and Practice for 12 months

Allied Medicine - 3 months

General Surgery - 3 months

Gynaecology and Obstetrics - 3 months

Paediatrics - 3 months

Clinical Skills : Differential diagnosis, patient care, medical record-keeping, and treatment planning.