Hi, I’m
Tabish Zaman Khan
Dubai
Summary
With nearly 11 years of honing my organizational prowess in high-pressure, deadline-driven settings, I am eager to embark on a stimulating journey in the Administrative Industry. My background is a testament to my ability to navigate demanding work environments with agility and precision. I am now poised to channel this robust skill set into a challenging career, where my dedication to excellence will drive success and add value to my future employer.
Overview
9
years of professional experience
Work History
burjeel holdings
RCM Manager
07.2023 - Current
Job overview
- Expertise in end-to-end Revenue Cycle Management (RCM), including authorizations, coding, claim submissions, and resubmissions
- Revised Authorization Guidelines to align with DRG Billing, enhancing DRG Value and implementing risk profiling for comprehensive revenue management
- Proficient in Payer Management, encompassing empanelments, strategic communications, audits, and network expansion
- Skilled in Revenue Optimization and maintaining Revenue Integrity for financial growth
- Advanced knowledge in Clinical Documentation Improvement to enhance billing accuracy
- Comprehensive Denial Audit and Analysis to minimize financial losses
- Effective in leading Physician and Staff Training for improved RCM processes
- Experienced in managing Regulatory and Third-Party Audits, including DHA and insurance company evaluations
- Adept in Budget Management, ensuring fiscal responsibility and cost-effectiveness
- Committed to Quality Management, upholding high standards in healthcare services
- Successful EMR Implementation and Training, enhancing operational efficiency
- Strategic Planning expertise to drive organizational success and revenue cycle efficiency
Thumbay Group
Sign off & Reconciliation Manager
05.2022 - 07.2023
Job overview
- Achieved a maximum annual rejection rate of 4.7%, ensuring reimbursement optimization in compliance with UAE Federal government and payer-specific billing requirements
- Managed sign-off and reconciliation processes for Thumbay Group, encompassing 4 hospitals and 7 clinics
- Led a team of 19, overseeing the reconciliation and sign-off procedures, ensuring timely financial year-end closures
- Supervised the implementation of RPA for Claims Accounts Receivable Payment posting, liaising with developers for automation enhancements and handling claim reconciliations
- Monitored billing accuracy and spearheaded efficient account collections, including claim submissions and follow-ups on discrepancies
- Coordinated with payers to address and rectify unjustified claim rejections
- Analyzed transactional data between providers and payers, contributing to strategic decision-making
- Prepared detailed rejection analysis reports, informing management of denial trends for targeted resolution
- Facilitated quarterly and semi-annual closures with insurance companies, ensuring timely settlements
- Oversaw Revenue Cycle operations for Thumbay Group, enhancing cash flow and customer relations
- Played a pivotal role in system upgrades, collaborating with IT for daily enhancements and UAT processes
- Identified and communicated administrative rejection trends to internal stakeholders for continuous improvement
- Prioritized and expedited the processing of high-value rejected claims with insurance entities
- Diligently followed up on Accounts Receivables, focusing on outstanding and rejected claims
- Monitored resubmission of e-claims across all facilities, ensuring compliance and efficiency
- Drove monthly collection teams towards achieving set financial targets
- Developed strategic plans with management to foster business growth at the network level
- Conducted Gap Analysis to identify discrepancies between provider billings and payer reimbursements
- Coordinated with IT for system updates, streamlining Auto reconciliation processes for both outpatient and inpatient services
- Managed legal team requirements to recover outstanding debts from absconding insurance companies
- Motivated team members to reach optimal productivity levels and coordinated training for resource development
Saudi German Hospital, Ajman
Insurance Supervisor
03.2019 - 05.2022
Job overview
- Expertly empaneled all insurance companies and established direct billing corporate relationships for Ajman facilities, achieving early integration prior to soft launch
- Spearheaded DRG calculation processes and successfully negotiated factors with insurance providers to optimize revenue
- Revised Authorization Guidelines to align with FFS Billing, enhancing FFSValue and implementing risk profiling for comprehensive revenue management
- Drove patient inflow for the Surgical Department by coordinating competitive pricing strategies with the CEO, attracting both in-network and out-of-network cases
- Managed the entire Revenue Cycle Management for Ajman, implementing strategies to minimize rejections and prevent revenue recovery issues
- Led front and back-office teams, ensuring adherence to KPIs, business objectives, and efficient operations in authorization, submissions, and reconciliations
- Initiated and guided HIS system enhancements with vendors to meet current market demands and ensure DHA compliance
- Conducted thorough testing and reporting on system bugs and business reporting accuracy for optimized operational performance
- Ensured exceptional customer service across three facilities, resulting in increased direct billing partnerships with international insurers and assistance companies
- Reviewed and integrated new pricing items into the claims adjudication process, aligning with the general ledger for seamless revenue and incentive distribution
- Facilitated regular training for medical and customer service staff on insurance protocols and policies to maintain high service standards
- Conducted biannual appraisals and contract renewals for the insurance department, including authorization, coding, and claims teams
- Oversaw the meticulous submission of claims for Insurance/TPA & Corporate Clients, adhering to e-claims billing standards
- Maintained strict KPI compliance for claim submissions, coordinating with the Billing Supervisor to address any delays
- Prepared monthly claim reports and collaborated with the Finance Team for account reconciliation and closing
- Regularly audited claims to maintain a rejection rate below 5%, coordinating with insurers for reconciliation of rejected bills
- Managed outpatient and pharmacy approval processes and demonstrated proficiency in handling inpatient approvals
- Ensured accurate HIS updates of discount tariffs in accordance with contracts and verified the availability of all necessary documents for claim submissions
- Collaborated with medical coders to ensure precise mapping of CPT and ICD codes, maintaining billing accuracy and compliance
Saudi German Hospital, Dubai
Claims officer
08.2015 - 03.2019
Job overview
- Spearheaded the claims submission process for corporate clients and insurance, ensuring seamless coordination with Accumed TPA
- Facilitated the collection of necessary documentation for claims processing, including initial submissions and multiple resubmissions
- Managed the maintenance and updates of the hospital's accepted insurance network list
- Oversaw the correction of billing and policy errors, collaborating with billing staff to ensure accuracy
- Developed and implemented policies and strategic plans to enhance claims operations
- Addressed and resolved billing complaints in partnership with the Billing Supervisor
- Conducted meticulous reviews of daily invoices to ensure compliance with insurance policies and company contracts
- Verified patient insurance eligibility and ensured the correct application of contractual discounts
- Ensured necessary insurance approvals were obtained for specific medical procedures
- Maintained and monitored Key Performance Indicators (KPIs), documenting and reporting any discrepancies to the Billing Supervisor
- Coordinated across multiple departments to complete thorough claims documentation, ensuring compliance with medical and insurance requirements
- Guaranteed the attachment of all pertinent documents to claims, including bills, reports, and necessary approvals
- Collaborated with medical coders to ensure accurate CPT and ICD coding on claims
- Liaised with finance, insurance, and corporate stakeholders for claim rejections and resubmissions
- Provided support to the Outpatient Preauthorization team, maintaining KPIs and documentation for audit purposes
Education
Delhi University
Bachelor
Showbit University
MBA
AAPC
CPC
Skills
- Management
- Communication
- Strategic Planning
- Health Insurance Claims audits
- Team Management
- Revenue Cycle Management
- Market Analysis
- Microsoft Excel
- Claims handling
- Healthcare Benefits
- Denials Management
Languages
English
Personal Information
- Nationality: Indian
- Driving License: True
- Marital Status: married
Timeline
RCM Manager
burjeel holdings
07.2023 - Current
Sign off & Reconciliation Manager
Thumbay Group
05.2022 - 07.2023
Insurance Supervisor
Saudi German Hospital, Ajman
03.2019 - 05.2022
Claims officer
Saudi German Hospital, Dubai
08.2015 - 03.2019
Showbit University
MBA
AAPC
CPC
Delhi University
Bachelor
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