Summary
Overview
Work history
Education
Skills
Custom
Personal Information
Timeline
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Mithundas V P

Dubai

Summary

A Hardworking, dynamic, confident, organized person who enjoys being part of, as well leading, a successful and productive team, whilst able to work well on own initiative. Thriving on learning new skills and quick to grasp new ideas and concepts, with the proven ability to train and motivate others. Highly organized and results oriented, demonstrating the highest levels of motivation required to meet tight deadlines while working in highly pressurized environments. Possessing excellent interpersonal skills with the ability to communicate concisely at all levels. 21 years of experience in Healthcare Insurance Business mainly Revenue cycle management that includes Billing, coding, pre-approvals, Submission, resubmission, reconciliation, Collections, audit, Quality, Networking etc.. Have very strong networking and coordinating Skills with excellent relationship with all heads of major insurance companies across UAE and some international companies with excellent understanding and knowledge of healthcare systems and medical terminologies. RCM Director with background in service leadership roles. Coordinates daily operations through strategic staff and resource planning. Knowledgeable about industry trends and focused on remaining ahead of competitors by proactively meeting evolving consumer demands. Dedicated RCM Director with 21 years of experience. Demonstrated history of meeting company goals and promoting best practices. Thrives under pressure and adapts to challenges with ingenuity and resilience.

Overview

21
21
years of professional experience
8
8
years of post-secondary education

Work history

Group Director of RCM/Insurance

Emirates Hospitals Group
Dubai
06.2020 - Current
  • Handling functions of 40+ entities including 2 Hospitals, 3 Daycare centers and 35 clinics midsmall sized including high till low end networks
  • Portfolio of AED 600 million plus…

Group Insurance Director/RCM

Novomed Hospitals and Clinics
Dubai
11.2018 - 06.2020
  • Responsible for all activities related to RCM & Insurance operations from start till end including Billing, pre-approvals, Coding, reviews, audit, submission, resubmission, Denial management, reconciliation, collections, until AR and final closing
  • Business strategy, Networking, empanelment, Advisory role, projects, Due diligence, acquisitions both green and brown fields, DHA & DOH(HAAD) relationships
  • Joint venture, business plans, feasibility study, operating plans etc.
  • AUH Tasneef and Jawda quality audit preparations & scoring, CDI, trainings, mock inspection, training staffs on the requirements as per protocols
  • Accurate decision on various Surgery cost estimates on group level AUH and DXB based on patient needs & branch managers decisions without comprising on the cost and profit
  • Strict periodical Contract maintenance with insurance companies
  • Receiving referrals for surgeries, health packages, special agreements from insurance companies CBD contracts with other hospitals and vice versa for the hospital
  • Doctors liaison for all kinds of queries on administrative and insurance operations level
  • Daily liaison and guidance to HR coordinators on various insurance policies such General, Medical Mal- practice, multi risk, property, fidelity, indemnity, workmen compensation
  • Addition and deletion of staff members etc…

Group Insurance Manager/RCM

Emirates Healthcare Group
Dubai
01.2016 - 01.2018
  • Handled 37 entities during the tenure including 2 Hospitals, 2 Daycare centers and 31 clinics mid-small sized including high till low end networks
  • Handled and responsible for close to AED 300 million Insurance revenue on group level
  • More than 80 plus Insurance RCM staffs reporting to me from multiple locations throughout UAE
  • Pricing negotiations, yearly eligible increases, DHA and HAAD meetings etc..including mandatory Tasneef and Jawda certification and scoring requirements
  • Travelling frequently to all the entities to ensure smooth insurance operations and meeting all the practicing doctors
  • Meetings with all the insurance companies for expansions, acquisitions, empanelment, pricing strategy, network placement locality wise, market studies etc
  • Helping NMC hospitals and clinics whenever requested and required by the management in all insurance aspects mostly empanelment and networking, addition and inclusion of services through negotiations
  • Unified cash prices across all entities by studying market similar like- wise hospitals.

Insurance Manager/RCM

Emirates Healthcare Group
Dubai
01.2013 - 01.2016
  • Managed the RCM & Insurance operations at 12 clinics, 1 hospital and 1 day care center including AUH and DXB
  • Networking, empanelment, negotiations, pricing, inclusions etc.
  • Lead and train submission, resubmission, reconciliations and audit teams
  • Billing department overview and supervisions, entity wise cashier training
  • Encouraged and advised the whole team to get training on CPT, ICD, HCPCS with written exams either training or certifications
  • Preparation of various management reports and submitting
  • Authority dealings, HAAD and DHA
  • Various periodical statistical reports submitted to DHA
  • Functional and partially reporting by MRD department
  • Meeting insurance companies frequently for network additions, service inclusion, pending payment follow-ups, reconciliation.

Asst.Insurance Manager

Emirates Healthcare Group
Dubai
01.2010 - 01.2013
  • Daily supervision of cashiers, coordinators and officers
  • IP bill screening, Pre-approvals screening both OP & IP
  • Insurance Master Tariff up dation as per mutually agreed rates with insurance companies respectively
  • Responsible for Pre-approval TAT
  • (Achieved 24 hrs TAT for elective and
  • TAT for emergencies
  • Support to billing manager in claim scrutiny
  • Monitoring of submission team to ensure timely submission of claims
  • Tariff negotiations, yearly tariff/price increase
  • Responsible for Maintaining the master tariff in excels and folders
  • Frequent training to cashiers and pre-approval coordinators
  • Orientation on new policies and procedures
  • Daily updates on various insurance information's about policies, network and updates
  • Coordination with insurance companies for emergency and elective complicated IP cases
  • Responsible for Pre-approvals and dealing with treating doctors.

Sr. Insurance officer

Emirates Hospital
Dubai
02.2006 - 01.2009
  • Attending and solving Patient's queries relating to medical insurance
  • Maintaining strict vigilance with regards to compliance of company/insurance policies, procedures and protocols
  • Processing of insurance claims
  • Coordinating with the Doctor's, insured member and the insurer for all queries relating to medical claims
  • Responsible for obtaining approvals from insurance companies for planned procedures requiring pre-authorization
  • Maintaining daily reports of approvals and follow-up's
  • Assisting reconciliation team to analyzing of rejected claims from insurance companies and helping them resubmitting after complying with the required documentation and protocols
  • Maintaining, updating and providing information of insurance and corporate clients to all concerning departments
  • Scrutiny of medical claims of Insurance companies with regards to compliance of company/insurance policies, procedures and protocols
  • Coordinating with Doctors, Medical Records and Departments for the necessary documentation required for the submission of medical claims
  • Orienting & Briefing the newly joined doctors and nurses about the insurance policies and following hospital practices
  • Supervising the dispatch team for Submission of Invoices to the respective Insurance companies on monthly or fortnightly basis
  • Helping the Insurance reconciliation Team for the monthly rejected medical claims and reporting to the Finance Department.

Cashier supervisor/Insurance coordinator

Emirates Hospital
Dubai
01.2005 - 01.2006

Insurance CASHIER

Emirates Hospital
Dubai
09.2003 - 02.2005
  • Supervision of patient billing
  • Attending patient's billing queries
  • Liaising with doctors/ credit customers/Insurance companies
  • Analysis of disallowance from insurance companies
  • Scrutiny of Bills raised on a daily basis
  • Preparation of monthly Discount Statements of corporate and insurance companies
  • Responsible for preparation and dispatch of monthly statement and Invoices to Corporate & Credit Customers
  • Cash management, accounts payable & accounts receivables
  • Billing insurance (credit invoice) invoice
  • Billing the Inpatient invoice by checking the appropriate tariffs for CBD (clinics) & insurance tariffs
  • To manage the monthly general financial reports and summaries according to Doctors credit and cash invoice
  • Liaising with Insurance and corporate clients
  • Maintaining Petty cash claims and other office expenditure claims
  • Cash planning and Management.

Education

Diploma in Computer Technology (DCT) -

Sai Ram Polytechnic, Madras University
01.1996 - 04.1999

Bachelor of Computer Applications (BCA) - undefined

University of Madras
01.1999 - 04.2003

Advanced Diploma in Computer Hardware and Networking (ADCHN) - undefined

RJPCIT Pvt ltd

Certified Coding Associate- CCA - undefined

Master of Business Administration- Hospital Administration - undefined

Manav Bharti University

Pursuing, PHD Doctorate - Business & Healthcare Management

Madurai Kamaraj University, Tamilnadu, India
India

Skills

  • Compliance understanding
  • Financial administration
  • Training and development
  • Vendor sourcing
  • Analytical problem solving
  • Technology integration
  • Proposal creation
  • Interdisciplinary collaboration
  • Hiring and training
  • Programme development
  • Leadership
  • Knowledge of Various HIS systems
  • Team building
  • Public relations
  • RCM operations Management
  • Problem-solving
  • Time management
  • Multilingual
  • Communication skills

Custom

I hereby declare that the above details furnished by me are true to the best of my knowledge.

Personal Information

  • Date of birth: 01/26/1981
  • Nationality: Indian
  • Marital status: Married

Timeline

Group Director of RCM/Insurance

Emirates Hospitals Group
06.2020 - Current

Group Insurance Director/RCM

Novomed Hospitals and Clinics
11.2018 - 06.2020

Group Insurance Manager/RCM

Emirates Healthcare Group
01.2016 - 01.2018

Insurance Manager/RCM

Emirates Healthcare Group
01.2013 - 01.2016

Asst.Insurance Manager

Emirates Healthcare Group
01.2010 - 01.2013

Sr. Insurance officer

Emirates Hospital
02.2006 - 01.2009

Cashier supervisor/Insurance coordinator

Emirates Hospital
01.2005 - 01.2006

Insurance CASHIER

Emirates Hospital
09.2003 - 02.2005

Bachelor of Computer Applications (BCA) - undefined

University of Madras
01.1999 - 04.2003

Diploma in Computer Technology (DCT) -

Sai Ram Polytechnic, Madras University
01.1996 - 04.1999

Advanced Diploma in Computer Hardware and Networking (ADCHN) - undefined

RJPCIT Pvt ltd

Certified Coding Associate- CCA - undefined

Master of Business Administration- Hospital Administration - undefined

Manav Bharti University

Pursuing, PHD Doctorate - Business & Healthcare Management

Madurai Kamaraj University, Tamilnadu, India
Mithundas V P