JOHN LIGORIO DSOUZA

Results-oriented and compassionate professional with 18 years of experience in the healthcare industry in the UAE, specializing in operations, including customer service, CRM, billing, and case management. Expertise includes a deep understanding of patient satisfaction, revenue enhancement, and Medical insurance protocols, along with a strong track record in leadership and team collaboration. Known for effectively managing multiple projects while streamlining workflows to boost operational efficiency and enhance service quality. Dedicated problem solver committed to achieving organizational goals through meticulous planning, resource management, and a proactive approach to challenges.

• Supervised team of [Number] staff members.
• Achieved [Result] through effectively helping with [Task].
• Achieved [Result] by completing [Task] with accuracy and efficiency.
• Used Microsoft Excel to develop inventory tracking spreadsheets.
• Documented and resolved [Issue] which led to [Results].
• Collaborated with team of [Number] in the development of [Project name].
• Resolved product issue through consumer testing.
• Achieved [Result] by introducing [Software] for [Type] tasks.

• CAP - Certified Administrative Professional

• Oversee day-to-day operations of the assigned department.
• Hire and train staff involved in processing claims.
• Conducted performance evaluations that are timely and constructive.
• Conducted audits and alerted relevant personnel/ departments if documentation is inadequate.
• Ensuring DRG coding is accurately done as per the DHA unified list, HIM coding, Billing, insurance and claim process under various platforms.
• Ensuring claims are efficiently processed on time and accurately to ensure timely reimbursements payments are received and monthly targets are achieved.
• Ensuring there are no complaints from patients which are managed in the Front Office Dept. i.e. from patient Registration until discharge Process.
• Maintained client documentation as per local authority regulations & billing requirements.
• Supervised long stay admitted DRG cases and to assist staff in updating the insurer in timely manner to avoid difficulties in obtaining final approval after discharge.
• Checked the discharge time should not exceed 48 hrs. and ensure the staff update the insurer in a timely manner.
• Supporting and guiding claims management staff as and when required.
• Ensuring staff meet their deadlines and proper counseling done if required.
• Prepared Duty Rota, medical/legal reports and corresponds with attorneys, insurers, and other stakeholders as needed.
• Identified documentation requirements, acquiring authorizations, pre-approval request and claim correction.
• Reviewed medical claims for errors before sending them to responsible parties.
• Briefed narrative reports to be shared with the applicable service providers.
• Performed other related duties as assigned.
• Attending weekly meetings with Admin Manager to discuss the payments/flow of patients/complaints of patients so as to overcome of any issues in the department.