MOHAMMED ASHRAF UA

Founded in Australia in 2003, Aspen Medical Group is a global provider of innovative healthcare solutions. The company has a diverse range client in government, non-government organization (NGO) and the private sector.

In UAE, running DOH Project of six primary healthcare centers in remote areas of Abu Dhabi for support and extend service to people living there.

Responsible for whole RCM activities in six Primary Health Care Centers in remote areas of Abu Dhabi and working together with 10 members of team and reporting to the Finance Manager by global software Oracle & ProcessMed Healthcare System.

PRIMARY RESPONSIBILITIES:

• Preparation of Daily Flash Report and submission to stakeholders.
• Key Outputs Prospective Insurance companies identified, agreements reviewed, the selection made and contracts awarded.
• Validating the payment request for construction vendor and accounting the same in Oracle.
• Processing any other payments related to clinics.
• Uploading the pricelist for cash and insurance patients in HIS.
• Coordinating with the Oracle consultant for integration and providing support.
• Coordination with IT team for any Process med related activities (Reports, integration, etc).
• Assisting stock verification in clinics
• Accountable for overseeing the billing accounts, DSO Days and Rejections.
• Ensure good relationship with TPA/Insurance co. Finalize the discounts and pricing, Volume Rebates and Factors with Payers.
• Exhausted benefits identified in close liaison with resubmission team to ensure maximum recovery from insurance companies.
• Responsible for insurance collection and empanelment for new facilities.
• Data Analysis, Management Reporting, Market Sensitivity Analysis, Rejections, Sales Mix, ARPP, High Value prescriptions, Insurer Ranking etc.
• Denial control measures and Effective resubmission.
• Manages all functions of the organization’s billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations.
• Preparation of insurance report on monthly sales, collection report and financial reports to management.
• Coordination with insurance companies in regards to any operational matters.
• Drafts narrative reports to be shared with the applicable service providers.
• Facility account registration in Shafafiya system with coordination of regulatory support team professionals.
• Establish, communicate, and manage goals and expectation for the department and individual performance.

Holding the No.1 position in Healthcare Retail Sector for Most Admired Retail & Best Customer Care Service and having more than 250 retail units all over U.A.E and is on the path of expansion.

Responsible for whole insurance activities in entire retail outlets and working together with 10 members of team and reporting to the General Manager by using internal software Microsoft Dynamics AX 2012 R3 & Retail Pro Software.

PRIMARY RESPONSIBILITIES:

• Managing the insurance team and control day to day activities.
• Preparation of insurance report on monthly sales, collection report and financial reports to General Manager and management.
• Coordination with insurance companies in regards to any operational matters.
• Worked in different levels of medical insurance claim processing.
• Reviews insurance claims for errors before sending them to responsible parties.
• Drafts narrative reports to be shared with the applicable service providers.
• Facility account registration to the DHA and Shafafiya system with coordination of regulatory support team professionals.
• Liaison activities with insurance companies for pharmacy inclusions and other network activities and AX system configuration for pharmacy empanelment.
• Co-ordination with Payers with regards to inclusion of clinics in their network
• Responsible for analyzing Insurance Transactions in Microsoft Dynamics AX 2012 R3 & Retail Pro in accordance with insurance procedure.
• Daily claim submission to insurance companies through Microsoft Dynamics system.
• Reconciliation and outstanding follow ups with insurance companies.
• Resubmission of pharmacy and clinic claims rejected claims through Microsoft Dynamics system.
• Managing and supporting retail outlets for insurance approval related queries.