Lakshmi Marshad
Dubai
Summary
Dynamic and results-driven Provider Relations professional with over 12 years of experience managing a diverse network of more than 2,200 healthcare facilities. Adept in contract negotiations, pricing analysis, and regulatory compliance, with proven success in implementing operational strategies that drive efficiency and ensure alignment with health authority standards. Fluent in English, Hindi, and Malayalam, with a strong ability to communicate and collaborate across cultural and professional boundaries.
Recognized for building and sustaining strong relationships with healthcare providers and acting as a key liaison between organizations and stakeholders. Demonstrates a strategic mindset backed by hands-on expertise, consistently exceeding performance targets in high-pressure, fast-paced environments. Committed to delivering impactful, data-driven solutions that support organizational goals and long-term success.
Overview
16
16
years of professional experience
Work History
Medical network Executive
NATIONAL GENERAL INSURANCE COMPANY (NGI)
09.2022 - Current
- Responsible for all aspects of participation in contracting with assigned providers
- Implement strategies to accurately determine the cost of the provider to NGI
- Acting pricing analyst and negotiator upon management request
- Negotiated provider agreements,reducing costs by 20-25% while maintaining optimal services and payment terms,directly supporting organizational pricing goals
- Carryout procedure code mapping for the contracted services with the healthcare providers as needed
- Ensuring that all negotiations are in line with the companies pricing targets, optimum services, and payment terms
- Provide orientation and training to newly empaneled providers
- Managed any issues that may arise from the providers and ensure that these are addressed and resolved in a timely manner
- RA allocations and timely follow ups from internal departments
- Prepare required communications such as circulars and instructions to providers for updates of policies and processes
- Complaints and Compliance management
- Monthly Network updates
Specialist-Insurance
SHEIKH MANA BIN HASHER AL MAKTOUM POLYCLINIC
12.2021 - 07.2022
- Scrutinize claims prior to submission by cross-matching diagnoses and services in the EMR
- Check for coding errors and rectify the same
- Attend to queries from payers/TPA regards to clinic documents/Trade license/clinician licenses
- Communicate with doctors in making corrections in the EMR for ICD/CPT codes
- Co-ordinate with submission staff for addition/deletion of CPT codes
- Educate/train doctors and nurses on correct EMR documentation and coding
- Carry out addition/deletion of ICD codes with reference to EMR by notifying the treating doctor
- Maintain performance standards as specified by departmental policies
- Getting approvals for insurance patients
- Ensuring coverage of claims, submission, resubmission etc
- Getting the Remittance on time
- New empanelment with insurance companies
Officer-Provider Network Relations
OMAN INSURANCE COMPANY - DUBAI, UAE
08.2017 - 09.2021
- Provider Relation Management - Point of Contact between OIC and 2200 healthcare facilities within UAE starting from Procurement to Termination
- Complaints and Compliance management - resolve provider related complaints within TAT, act upon notices from Health Regulatory bodies including termination of the providers
- The initial approving authority for Provider addition or suspension
- Acting pricing analyst and negotiator upon management request
- Contracts and Documentation Management - in-charge of contracts and legal documents of network providers
- Orientation for newly empaneled providers in OIC Network
- Network Operations - generate a monthly report with data of OIC Network providers for circulation among OIC stakeholders, responsible for revising the OIC Provider Manual
- Project Management - a) Launch of the internal PBM system and updating all Pharmacy providers with discount rules.
- New Inclusion: within SLA upon Contracting & Pricing approval.
- Termination: Immediate or as per notice period with 100% accuracy.
- Service Addition and price list: Within TAT with 100% accuracy with minimal claim impact.
- CPT Mapped price list upload: Within TAT with 100% accuracy with minimal claim impact.
- Provider Meeting: Training and orientation to new providers, Build relationships with clients and providers in coordination with Sales & OIC stakeholders.
- Provider Communication: Communication to the providers on OIC Protocols, Circulars, Manual/Guidelines, HAAD/DHA updates. -Updating provider manual and PowerPoint presentation
Senior-Executive-Provider Relation
AAFIYA INSURANCE
03.2017 - 07.2017
- Empanelment.
- Making network provider Agreements.
- Making Addendums to the Network provider agreements.
- Pricing comparison and tariff negotiations.
- Software Updating.
- Supporting all the providers for resubmission and reconciliation.
- Making a presentation for the new network initiatives.
- Reporting to Manager-Network regarding all the updates, discount changes and all over the process daily.
- Price list uploads.
- Rejection reports and no due certificates.
- Provider Orientation.
- Reconciliation.
- Provider Meetings in Office / Visits & Resolution.
- Provider Utilization review and Price Negotiation (FWA), Utilization review.
- Volume Rebate Follow-up
Executive-Insurance
PRIME HEALTHCARE GROUP DUBAI, UAE
01.2015 - 01.2017
- Claim Processing.
- E claim Processing.
- Resubmission.
- Circulated documentation as needed for review. prepared insurance forms and associated correspondences.
- Sort out the rejection as per denial reason.
- Sending the rejected claims for the respected doctors for justifying the claims if necessary and follow up with the doctors within the specified time.
- Preparing rejected claims for resubmission.
- Submitted the claims with proper codes and format to insurance companies.
- Minimized claim rejections by implementing a rigorous pre-submission audit process, scrutinizing 50+ claims daily for coding accuracy and adherence to payer guidelines, resulting in a 15% decrease in final denials.
- To meet the resubmission productivity targets within the stipulated time for all insurance companies
Insurance Coordinator
DM HEALTHCARE - DUBAI, UAE
03.2012 - 12.2014
- Managed filing and tracking insurance claims and informed patients for the status of their claims.
- Processed insurance and disability claims in a timely manner.
- Handled patient's queries regarding unpaid balances.
- Circulated documentation as needed for review.
- Prepared insurance forms and associated correspondences.
- Submission of insurance claims on a monthly basis.
- E-claims submissions.
- Taking verbal and written approvals from insurance companies.
- Maintained strict confidentiality related to medical records and other data.
- Provided customer-related claims and billing assistance.
- Filed and tracked insurance claims and communicated claims status to patients.
- Obtained data such as patient, insurance ID, insurance provider, and medical codes to properly file insurance claims.
- Trained staff on current Medicare regulations and guidelines.
- Maintained compliance with local and national regulations governing insurance, including Medicare and Medicaid requirements.
- Verified insurance and communicated coverage to staff and patients.
- Co-ordinated withkept Chief Operating Officer with daily operational functions.
- Analyzed departmental documents for appropriate distribution and filing
Supervisor-Customer Service
ASTER HOSPITALS
10.2009 - 12.2011
- Provided instruction, coaching and motivation to all employees during the shift.
- Analyzed accounts and processes to improve customer experience.
- Kept accurate and detailed records of personnel progress and productivity.
- Interviewed, hired and trained employees on new procedures and requirements.
- Guided and coached staff to achieve individual growth and sales production targets.
- Created and implemented strategies for improving operational efficiency and accuracy.
- Worked Extra hours in order to meet customers' requirements, solve their problems and thus encourage future business.
- Developed and implemented new systems, procedures or working practices to improve customer service efficiency
Education
BA -
CALICUT UNIVERSITY
01.2009
Higher National Diploma - CPC
AAPC
01.2025
BTECHNC - Aviation, hospitality, And Hotel Management
FRANKFINN INSTITUTE OF AIR HOSTESS TRAINING
01.2009
Skills
- Healthcare contracting
- Claims Management
- Provider Network Management
- Healthcare Regulations & Compliance
- Data Analysis & Reporting
- Healthcare Pricing
Languages
English
Hindi
Malayalam
Timeline
Medical network Executive
NATIONAL GENERAL INSURANCE COMPANY (NGI)
09.2022 - Current
Specialist-Insurance
SHEIKH MANA BIN HASHER AL MAKTOUM POLYCLINIC
12.2021 - 07.2022
Officer-Provider Network Relations
OMAN INSURANCE COMPANY - DUBAI, UAE
08.2017 - 09.2021
Senior-Executive-Provider Relation
AAFIYA INSURANCE
03.2017 - 07.2017
Executive-Insurance
PRIME HEALTHCARE GROUP DUBAI, UAE
01.2015 - 01.2017
Insurance Coordinator
DM HEALTHCARE - DUBAI, UAE
03.2012 - 12.2014
Supervisor-Customer Service
ASTER HOSPITALS
10.2009 - 12.2011
Higher National Diploma - CPC
AAPC
BTECHNC - Aviation, hospitality, And Hotel Management
FRANKFINN INSTITUTE OF AIR HOSTESS TRAINING
BA -
CALICUT UNIVERSITY
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