Ask Question / Post resume

Post a reply to the thread: STARWELL HEALTH MANAGEMENT Dubai/ UAE : MEDICAL CLAIMS OFFICER

Your Message

Your Username:

Notes:-
1) You can copy and paste your full resume in the box below.
2) Or you can ask your question. We try to answer, as far as possible.

Title:

[QUOTE=Dr.Rahul Sahare;200294]Dr.RAHUL SAHARE
[b]E-Mail [/b]: rahul_sahare AT yahoo.com 
 
[b]My Career Objective [/b]:
 
To work and prove as Healthcare professional with a career path in healthcare insurance . Strenghts include maintaining policies, project management, process improvements for Quality Assurance & program development in order to increase productivity within an organization.
[b]Academic Education [/b]: 
- LICENTIATE from Insurance Institute of India.
 
- PGDHM (Post Graduate Diploma In Hospital & Health Care Management)
Majors Are 1. Quality in Hospital & Healthcare
 2. Operations in Hospital & Healthcare 
- MBA (Master In Business Administration).
Major in HR, from Gauhati University, Guwahati, India 
- Bachelor of Ayurveda medicine and surgery 
[b](B.A.M.S. – 5 & 1/2 year degree), from [/b]:
Government Ayurveda medical college and Hospital, Jabalpur, m.p.
 RDVV, Jabalpur University, India
[b]Executive summary [/b]:
1.Emeditek ( TPA ) solution limited , Gudgaon , Haryana.
period- Dec 2011 to till now
Post-MEDICAL OFFICER
Job profile;
- Claims Management processes like authorization, adjudication, verification, audit etc
- Pre authorization and reimbursement of health insurance claims.
- Medical scrutiny of health insurance claims documents.
- Co ordination with insurance companies
- Reviewing cashless request
- TAT target – should maintain 100% TAT
- Evaluation of Treatment & Associated Costs
- Interaction with Health Care Providers and internal and External teams
- Responsible for claims management process authorization, adjudication, verification, audit, etc.
- Empanelment , supervise cashless services, claims reimbursement, Liaoning to clients
- Monitoring TAT..
- Resolving the grievances/queries by Head office/ Regional office/Insurer/ Beneficiary or any other party involved in claim.
- Make approval or denial decisions with claimants in accordance with policy provision.
2.Moolchand Medcity , New Delhi ( India’s 1st JCI & NABH accredited hospital )
Period- Nov 2010 to dec 2011
Post-Executive Manager in Operations
[b]Job profile [/b]:
- Responsibilities for hospital administration, TPA department coordination and other function to get approvals within time frame from TPAs and resolve related issues.
- Handle the team of quality circle group for quality assurance.
- Medical /clinical audit and investigation of medical files, discharge summaries and bills of insurance patients who are availing cashless hospitalization.
- To ensure that there is no discrepancy in proposed plan of treatment and treatment given during hospitalization and between preauthorization request and final document.
- To reply and quick response to the medical queries raised by TPAs / insurance companies.
- To minimize and prevent the deduction of funds at the time of recovery by giving expert opinion to TPAs/insurance companies.
- To coordinate with doctors regarding issues and discrepancies in preauthorization forms and discharge summaries and to resolve accordingly.
- To resolve the queries of patients regarding TPA process , copayment, capping, exclusion, and clauses like reasons for cashless denial, pre and post hospitalization benefit, pre existing disease, disease not covered.
- Tracking , maintain TAT and operating of discharge process to minimize the total discharge time starting from doctors discharge order to patient exit.
- Carrying and assisting in the various functions in the departments of medical services, quality assurance and marketing.
Achievements;
- TPA claim settlement ratio has been increased and denial ratio has been decreased by my efforts in a very short period and quires from TPA are very less at the time of final settlement / recovery.
- A project was done on hospital pharmacy management; suggestions were given to improve drugs availability and inventory control that are being implemented in the organization.
- A clinical audit was done on long standing IPD cases (stay more than 30 days ) that has proved to be very much helpful in context with quality indicator.
- A study was done on management of medication which earned lots of accolades from qualities assurance officers.
- Handle the overall responsibility regarding hospital operations.
- Responsible to provide a highest quality of care and best healthcare services in behalf of the hospital.
- Works as an auditor for revenue leakage audit and assist to the organization for improve the revenue generation. .
[b]Academic Professional summary [/b]:
- 1 year of internship in different department of Ayurveda medical clinical aspect.
- Having 3 months of experience in NATIONAL VACCINATION PROGRAM in district hospital, Jabalpur (m.p.) 
- 3 months of experience in gynaecology and obstratics services in LADY ALGIN DISTRICT HOSPITAL, JABALPUR, M.P.
- Work and special research on herbal medicine in the project of GHRITKUMARI {ALOE VERA BARBENDENCE}.
- Participated in different medical camp rural and village area run by the ministry of health, (Madhya Pradesh govt.) as a junior doctor..
- Summer training from Max healthcare ltd.(MSSH), Saket, New Delhi, in Quality Department.
- Successfully completed project on “Development of fall prevention program”
- Successfully completed project on “Hand Hygiene” 
- Exposure to various department at Max Hospital,saket, New Delhi. As a part of a team for audits, zonal and tracer.
[b]Knowledge and Ability [/b]:
- Able to handle corporate healthcare social responsibility such as welfare to work, philanthropy, alliances with community-based organizations. 
- Ability to meet targets within deadlines in an intensely competitive way
- A quick learner and a good team player
[b]Computer skill [/b]:
- Operating Computer in HTML, MS-Word, Excel, MS- PowerPoint, Ms-Access & All other program of MS- Office Application. 
- Typing on Computer speed of 45 WPM.
[b]Conference & Seminars [/b]: 
- National conference on “Quality management in hospital operation” held by AHA(Academy of Hospital Administration)
- ‘Leveraging Quality for Good Governance’ at New Delhi , organized by QCI (quality council of India).
- A Workshop on Six-Sigma, Hierank Business School, Noida (9th October, 09).
- A Seminar on Motivation by Mr. Anil Sethi (Speaker of International Repute)
- Workshop on Entrepreneurship by Dr. Vinay Aggarwal(chairperson, Pushpanjali Hospital) 
- A Seminar on Organizational Behaviors by Dr. Rajesh Bhalla (Ex CEO of Dharamshila)
[b]Interests [/b]: 
- Writing poem ( kavita ) 
- Dance
- Making hand crafts
- Interact with people
[b]Extra curriculum [/b]: 
- Participated and have done NCC and its rural & national camp.
- Participated in Poem Writing at state level.
- Participated in many Dance competitions.
- Organizer of Teachers day at AHA (Noida).
These above information are true to the best of my knowledge.
[b]Date [/b]: DR.RAHUL SAHARE
=======================================================[/QUOTE]

All times are GMT +5.5. The time now is 05:09 AM.