Dr. Saima Rafiq
Dubai,UAE
Summary
Accomplished professional with expertise in data analysis, adept at analyzing medical data and case studies to ensure accurate coding and claim adjudication. Demonstrates strong problem-solving skills, effectively resolving complex payer-provider disputes. Experienced in training and mentoring colleagues on best practices in IP pre-authorization and case management. Highly detail-oriented, ensuring compliance with DHA and DOH guidelines through meticulous review of medical records. Efficiently manages multiple cases simultaneously, showcasing exceptional time management abilities. Strong collaborator, working seamlessly with healthcare providers and insurance companies to streamline processes.
Overview
14
14
years of professional experience
1
1
Certification
Work history
Medical Claims Officer IP Aprovals- Case Management
Almadallah Healthcare Managment
Dubai
07.2025 - 12.2025
- Analyzed inpatient claims for medical necessity, policy coverage and compliance with DRG classification and ICD coding standards in line with insurance regulators(DHA, DOH and MOH).
- Analyze and validate DRG severity of illness (SOI)in line with revision of CPT codes/ ICD codes which are being upcoded by the provider - if required discussion with the treatuing doctor and the Medical coders, especially in high cost cases.
- Identified and flagged upcoding, unbundling and other potential billing irregularities for further invstigations.
- Referring cases for Second Medical Opinion when deemed necessary to confirm the best mode of managment - also for cost containment to lesser the negotiating factor (NF) facilities within the members network or option for home country treatment.
IP PRE-AUTHORIZATION MEDICAL OFFICER
NAS NEURON LLC
09.2023 - 07.2025
- Thorough knowledge of DRG codes and 3M application Tactical in handling ICD codes and CPT codes in 3m tracker to derive DRG codes with weights as per requirements.
- Tactical in handling approvals for maximum cost containment and aligned with policy terms and conditions.
- Well versed with deriving coding pathway using 3M DRG tracker to evaluate claims and Genuity of claim made with medical information provided.
- (Owned and managed by CIGNA International health insurance).
SUPERVISOR IN REIMBURSEMENT DEPARTMENT
NEURON LLC Dubai
09.2017 - 01.2020
- Auditing high-cost reimbursement claims of RAK, Morgan price, Enaya, Dubai world, Dewa, GCI and other top clients
Casualty Medical Officer
Government Medical College
Anantnag, Kashmir
01.2022 - 04.2023
- Casualty Medical Officer , Department of General Surgery
Resident Medical Officer
Government Medical College
Anantnag, Kashmir
04.2020 - 12.2021
- Resident Medical Officer, Department of General Medicine (GP).
Claims Officer
PENTACARE MEDICAL SERVICE LLC. Dubai UAE
01.2015 - 01.2017
- Reviewing, Auditing Medical Direct claims, E claims and Reimbursement Claims
- Auditing claims against eligibility as per Table of Benefits, medical necessity, ensuring the authorized services as per UCR (usual, customary, and reasonable) network rates.
- Review large and complex claims on basis of documented medical treatment guidelines, published medical research
- Analyze and enhance claims processes to optimize utility of resources and increase inefficiencies.
Resident Medical Officer
Modern Hospital
Rajbagh Srinagar, J&K
01.2013 - 01.2014
- Resident Medical Officer
Resident Medical Officer
Valley Orthocraft Nursing Home
Srinagar, J&K
01.2012 - 01.2013
- Resident Medical Officer
Education
MBBS, MD -
Shiraz University of Medical Sciences
Shiraz, IranDiploma - Aesthetic Medicine
American Academy of Aesthetic & Regenerative Medicine (AARM)
Dubai, UAESkills
- Data Analysis:
Proficient in analyzing medical data and case studies for accurate coding and claim adjudication
- Problem Solving:
Effective in resolving complex payer-provider disputes
- Training and Mentorship:
Experienced in mentoring colleagues on best practices in IP pre-authorization and case management
- Detail-Oriented
Highly detail oriented in reviewing medical records and ensuring compliance with DHA and DOH guidelines
- Collaboration:
Strong teamwork skills, working effectively with healthcare providers and insurance companies to streamline process
Certification
Medical Council of India (MCI): 13572
Accomplishments
- Best Employee of the year 2016
- Best Employee of the year 2018
- BLS , American Heart Association : 30 September 2022
- Certificate of Attendance on Updates in Interventional Cardiology on 20 Nov 2015 , awarded 5 CPD points by Dubai Health Authority ( Accreditation ID 1386/15).
- Certificate of Attendance on Workshop of Ophthalmology on 6th December 2015 , awarded 3 CPD points by Minstry Of Health ( Accreditation ID MOH /15/08851)
- Certificate of Attendance on Work shop of General Surgery on 11 December 2015 , awarded 3.25 CPD points by Dubai Health Authority (Accreditation ID DHA/1447/15)
- Certificate of Attendance on Pediatric & Neonatal care on 29 September 2021 , awarded 4 CPD points by Jammu & Kashmir State Medical Council under registration no. SMC/CME/S/Prog/21/325.
- Certificate of Attendance on Work shop of General Surgery on 7th July 2022, awarded 4 CPD points Jammu & Kashmir State Medical Council under registration no. MRCJ/CME/2022/138.
- Skyline medical coding center, Dubai, UAE CPC/AAPC 2024
Thesis Submitted on
Measurement of Hepatitis E specific RNA transcripts in peripheral blood of patients with hemodialysis and normal individuals using real time PCR compared to serological findings.
Timeline
Medical Claims Officer IP Aprovals- Case Management
Almadallah Healthcare Managment
07.2025 - 12.2025
IP PRE-AUTHORIZATION MEDICAL OFFICER
NAS NEURON LLC
09.2023 - 07.2025
Casualty Medical Officer
Government Medical College
01.2022 - 04.2023
Resident Medical Officer
Government Medical College
04.2020 - 12.2021
SUPERVISOR IN REIMBURSEMENT DEPARTMENT
NEURON LLC Dubai
09.2017 - 01.2020
Claims Officer
PENTACARE MEDICAL SERVICE LLC. Dubai UAE
01.2015 - 01.2017
Resident Medical Officer
Modern Hospital
01.2013 - 01.2014
Resident Medical Officer
Valley Orthocraft Nursing Home
01.2012 - 01.2013
Diploma - Aesthetic Medicine
American Academy of Aesthetic & Regenerative Medicine (AARM)
MBBS, MD -
Shiraz University of Medical Sciences