STARWELL HEALTH MANAGEMENT Dubai/ UAE : MEDICAL CLAIMS OFFICER

[Admin]

STARWELL HEALTH MANAGEMENT

Designation: MEDICAL CLAIMS OFFICER
Experience: 2 - 5 Years
Location: Dubai/ UAE
Compensation:
BEST IN THE INDUSTRY
Education: UG - MBBS - Medicine
PG - Any PG Course - Any Specialization
Industry Type: Insurance
Functional Area: Healthcare, Medical, R&D
Posted Date: 06 Dec 2008

Job Description
PRE-AUTHORISATION AND REIMBURSEMENT OF HEALTH INSURANCE CLAIMS.
LIAISIONING WITH NETWORK MEDICAL PROVIDERS.

Desired Candidate Profile
SHOULD BE A ALLOPATHIC MEDICAL GRADUATE WITH MINIMUM THREE YEARS EXPERIENCE.

Company Profile
A LEADING THIRD PARTY ADMINISTRATORS

Address:
Not Mentioned

Email Address:
sankar.etahr@gmail.com

Telephone:
Not Mentioned

Keywords: DOCTOR WITH AN APTITUDE FOR MANAGERIAL JOBS.

[Guest]

DOCTOR WITH AN APTITUDE FOR MANAGERIAL JOBS

[Guest]

#16, 6th Cross, Sirsi Road,
Chamarajpet,
Bangalore - 560 018
Karnataka - INDIA
Phone : +91 9886252422
+91 9886544270
Email:
Ashokn_1982@yahoo.com
Ashok Narayan
Objective To grow to higher levels in my profession, Exploring the new opportunities to gain deeper knowledge and in the process adding value to the growth to the company.

Education
Examination
Passed Institution Year of Passing % Of Marks
B.C.A S.R.N.Adarsh College 2003 69.89%
PUC Vijaya Composite College 2000 42.00%
SSLC Vijaya High School 1998 61.00%

Languages English, Tamil, Hindi, Telugu, Kannada
Work experience
- Affiliated computer services (ACS)
ITPL – White field
Bangalore - INDIA

From June 2008 to till date
ACS is a premier provider of diversified business process outsourcing (BPO) and information technology (IT) services and solutions to commercial and government clients worldwide. ACS is recognized as one of the best performing companies. As a FORTUNE 500 company, ACS has proven success delivering strategic value, business results, and operational gains to our clients. At ACS, it’s people, clients, and culture that make the difference.

- United Health Group (UHG)
Gurgaon - 122001
INDIA
From July 2007 to Feb 2008,
United Health care is a one of the largest US health insurance service providers in US and recently they launched the captive company in Haryana - INDIA

- HTMT Global Solutions Ltd, Bangalore.
Bangalore – 560058
INDIA
From April 2004 to July 2007,
HTMT has emerged as IT CO that delivers time and cost effective solutions to its vast & diverse client all over the world, adding value and simplifying life for its customers.

Designation
ACS - Senior Associate (Patient Account Representative)
UHG - Senior Claims Associate
HTMT- Senior Claims Processing Executive

Responsibility Undertaken - Capable of handling all kinds of claims (Medical, Hospita & Pharmal)
- CMS 1500 & UB04 Claims Adjudication (Accounts Payable)
- EDI and Paper claims processing. (EDI – Transactions)
- Generating calls to the insurance companies on daily basis in order to collect the payments (Accounts Receivable – AR Calling)
- Working with Knowledge Management Team
- Acting as a mentor for new processors
- Acting as auditor for those who are under mentoring
- Consolidating the necessary reports

- Trainer for medical claim processing executives
- SGH(small group head – Handling five to six examiners under my belt)
- Handling SHC (Special handling claims – VIP claims)
- Analyzing Production and Quality report of my Team members on daily basis to evaluate compliance with standards and outcomes and advising them for improvement in quality accuracy and timeliness.

Awards & Recognition - Always recognized as the best processor among the Floor
- Busy Bee award from the Hinduja TMT organization
- Champion of the floor award in 2008 from ACS organization
- Best performer award from United Health Group
- Certificates from the counter part based on exceeding the quality parameter
- Busy Bee award from the Hinduja TMT organization
- Captained Everest Cup (knowledge based game) successive 3 quarters
- Winners of the Everest Cup (Knowledge based Game)
- Recognized for adaptability skills and team support efforts. Regarded
highly by management for going “above and beyond” to ensure goals, timelines and effective team management.
Summary of Job
Affiliated Computer Services
RCMS – Revenue Cycle Management Services.
The Outbound process wherein we need to generate calls for ACCOUNTS RECEIVABABLE PURPOSE. Helping the US hospitals / physicians in recovering the AR (Account receivables) pending from a Healthcare service rendered to the patient.
1. Follow-up with US based Insurances to collect the pending amount on the Healthcare claims. (This would be done either through a call or online)
2. Meeting SLA / Quality standards as set by the Management
3. Undertake back office processing/ analytical activities
The process is semi - voice, wherein 70% of the time the agent will be involved in making outbound calls to the Insurance agents & 30% on analysis of the pending accounts.

United Health Group:
PROCESS 1 :TOPS Installation Process:
The online processing system is the process of coding into the system in order to help the system to perform auto adjudication.
PROCESS 2 :Claim Processing & Adjudication
Medical Claims, Hospital Claims and Pharmacy Claims processing as per the policies, state mandates and adhere to the healthcare rules & regulations

Hinduja TMT :
Business process outsourcing (IT enabled Services – ITES). Processing of U S health care insurance claims.
Our clients include one of the largest health insurance provider in US and customer service in United States.

ACAS – Automatic claim adjudication process:
- Processing HCFA-1500 & UB04 claims.
- Rectifying the Edits (Errors) and resolving the edits (Errors) in order to adjudicate the claim.
- Handling different kinds of claims like Medical, Hospital, RX etc
- Handling ECHS claims (Electronic Correspondence Handling System) - system used to process correspondence that is scanned in the system by a vendor.
- TAT target 7 days– should maintain 100% TAT(Turn around time)
- TAT for EPAY - should adjudicate the claim as and when it is spooled.
Quality target 99.90%

Personal Details Name : Ashok N
Father Name : Narayana A
Date of Birth : 24th November 1982
Sex : Male
Nationality : Indian

Hobbies Reading, Music, Playing Cricket & Visiting new places

Skill Sets C, C++, Visual Basic, MS Office, Windows 98, XP, Software Testing

Declaration:
I here by declare that the above-furnished details are true to the best of my knowledge.

Place: Bangalore
Date: ( Ashok N )

[Guest Poster]

Dr. Varsha Sharma
(B.H.M.S)

CAREER OBJECTIVE :
To obtain a suitable position in a Medically oriented environment that enables me to use my knowledge and gain working experience in the midst of patients of all categories affected in varying degrees.

SUMMARY OF QUALIFICATION
Worked as a Clinical trainee and intern in renowned multi-bedded super specialty hospitals.
Laudable experience of handling independently all OPDs and IPDs in a Hospital.
Experience in Clinical Research.

CLINICAL EXPERIENCE :

1) worked for 1 year in Vipul med corp (TPA) as a Medical Officer for
Processing claims, 4 months part time and 1 yr full time.
2) Worked in Trichology center as a Doctor/ Centre Manager for 9 year.3) Completed one year of internship at Bakson Homoeopathic Medical College and Hospital. During the internship worked in the following Departments:1. Medicine including Psychiatry, Dermatology, Pediatrics etc., (8 months).2. Surgery including ENT, Ophthalmology (1
month).3. Gynaecology and Obstetrics (2 months).4. Community medicine (1 month). 4) Completed 3 Months of clinical Training at Escort Heart Institute, Friends Colony, New Delhi .

5) Clinical experience of working with Dr.Chandra Mohan at his Clinic in Green Park , New Delhi .

6) Participated in many camps organized by “PEACE CHARITABLE TRUST”.

SEMINAR AND WORKSHOP:
1) Attended CME programme in management of IBS organized by A.I.I.M.G.A (ALL INDIA INDIAN MEDICINE GRADUATES ASSOCIATION) for family physician / general practitioners on 21st September 2007 at Moolchand Hospital , New Delhi .
2) Attended Practical workshop on “Pulmonary Disaster Management, Cardiopulmory Resuscitation and Homoeopathy” organized by American Safety and Health Institute (ASHI) and Homoeopathic Medical Association UK (HMA UK ).
3) Attended seminar on ‘MEDICO LEGAL INFORMATICS’ held on April 29th, 2007 at Sharda Hospital and Hindustan institute of Medical Sciences and Research, Greater Noida.
4) Awarded “Citizen of the world” title in a charitable camp Organized by PEACE CHARITABLE TRUST in association with TELEPERFORMANCE.

PROJECTS:

1) As a part of the curriculum, made a Project on “RHEUMATOID ARTHRITIS” during the internship under the Guidance and Supervision of DR.HARCHARANJEET KAUR (MD HOM., HOD GYNAE /OBS).
2) During posting in Preventive and Social Medicine, made a Project on “ANTENATAL CARE”.

MEMBERSHIP AND AFFILIATIONS:

1) Member of Board of Homoeopathic System of Medicine, Delhi . (Regn.No. BHSD/ NO. 003680.
2) Member of Peace Charitable Trust, Delhi , which works for the education of poor children.
3) Member of “Progressive Homoeopathic Society”.

EDUCATIONAL QUALIFICATIONS :

Ø Completed Higher Secondary From Lady Irwin Senior Secondary School , CBSE (2000).

Ø Completed Senior Secondary From Lady Irwin Senior Secondary School , CBSE (2002).

Ø Completed Bachelors of Homoeopathic Medicine And Surgery (BHMS) from Guru Gobind Singh Indraprastha University , Kashmere Gate, Delhi , (2002-2008).

EXTRA-CURRICULAR:

*Completed 1-month workshop from National School Of Drama, 1998.

*Completed 6 months Saturday Club from National School Of Drama, 1998-1999.

*Completed 6 months Saturday club part-II from National School Of Drama, 2000-2001.


PERSONAL DETAILS :

Name : Dr. Varsha Sharma
Father’s Name : Mr. G.S. Sharma
Date of Birth : August 27,1984
Age : 25 years

Sir/ Madam

Sub:- POST FOR MEDICAL OFFICER
As a qualified and meritorious Homoeopathic Doctor, graduated from a renowned college in Delhi , I am enclosing my Curriculum Vitae with the hope that you will consider the same for a suitable post in your reputed organisation.

I assure you that I shall discharge my duties to the entire satisfaction of my superiors, if selected.

Thanking you and looking forward to receiving positive response,

[Guest]

hi, im Dr shabnam ansari from new delhi india,im bachelor in medicine from india,i hav 3 yr experience as resident medical officer ,now chief medical officer in emergency in association of my work with medical certificates and claims,if suitable emailme on shabnamansari.rose@gmail.com or call to +919818168642,thank you

[Guest]

Hi my name is nephil tamang. i have done B.C.A And i have 2 and a half years of experience as a claim adjudicator. i work in wipro for united health group which is one of the best health care industry in usa. i am well acknowledged about the claim processing about the medicaid, other insurance and medicare too. my email id is nephil_2002@hotmail.com and my contact id is 9830797071. and yes i do know about notification and PRE-AUTHORISATION AND REIMBURSEMENT OF HEALTH INSURANCE CLAIMS. i also know about in network providers and out of network providers too.

[Guest]

want to join the job

[m s ahmed]

i am dr shakeel ahmed from india age 30years qualification bums (bachelor in unani medicine and surgery) work as resident medical officer in hospital in mumbai india seeking a job in hospital and healthcare institute in gulf

[Guest]

i m dr.parveen singh working in tpa(E-Meditek tpa services ltd) industry since august 2009 as a medical officer for processing & approving the medical claim. i want to do same job in gulf.

[Guest]

I m Doctor (medical officer A& E)in Oman since 2 years,,now i want to join as Doctor in A & E in UAE ,,so kindly accommodate me,,,thanks
Dr Shahid Khursheed khan

[Guest]

CURRICULUM VITAE
Personal information
Name : Zainab Dawoud Khaled Qandah
Email : zeze_q AT hotmail.com
Career Objectives :
- To obtain a good position that meets my potentials and improves my skills in order to fulfill my objectives.
Qualifications :
- Bachelor of Pharmacy from Philadelphia University (Jordan) 2002-2007.
- Complete 1440 hours training at Mysse Alreeem Pharmacy – Amman ,Jordan
________________________________________
Work Experience
1.
Pharmacist
Future Pharmacy, Dubai- UAE
July 2007 UP to November 2007
Customer Service Executive
Intertek International Ltd, Dubai-UAE
December 2007 UP to Date
- We basically do preshipment testing and inspection for products that are shipped into Saudi Arabia, Ensuring that no bad products are sold in the Saudi Arabia Market. So all the data base entry from the time of receipt of application till time of certificate issuance is controlled by me
- Provide customers with product and service information
- Answer phones and respond to customer requests
- Handling communication, correspondences with customers/exporters and following up on urgent exporters cases .
- Manage and resolve customers queries/ complaints
- Checking the test/analysis reports of the products to confirm complying with the standards.
- Verifying the inspection reports in order to confirm that the shipments have no discrepancy
- Main contact with our Labs & inspection offices and their related correspondences.
- Find out the outstanding and follow up with the client to settle out the payment
- Overall office work.
Computer Skills :
- MS Applications (Windows, Outlook, WinWord, Excel, Access, PowerPoint etc…)
- Internet browsing & E-Mail.
- Capability to use all of the computer programs used in the office work.
Languages
- Arabic and English (writing, speaking and reading)

[Guest]

DR PRABHULINGASWAMY SM MBBS MD DHA DIP IN HEALTH INSURANCE AGED 62 YEARS HAVING EXPERIANCE AS ADMINISTRATIVE MEDICAL OFFICER FOR 30 YEARS AND MEDICAL OFFICER FOR IN SURANCE CLAIMS SETTLEMENT FOR LAST 4YEARS AT APOLLO HOSPITAL MYSORE ,REQUIRES PLACEMENT CLAIMS SETTLEMENT EXECUTIVE MEDICAL OFFICER.

[Guest]

Cherryl Formento Eje,R.N.
Email Add : cherryleje AT yahoo.com
CAREER OBJECTIVE
To be able to make use of my expertise and knowledge in handling patients, newborns, paediatric, ER, OR, and management of hospital data for the progress and benefit of the organization.
EMPLOYMENT HISTORY
Position : Staff Nurse
Duration : July 07, 2008 - December 29, 2010
Company : Romblon Provincial Hospital
Address : Odiongan, Romblon, Philippines
Duties and Responsibilities :
A skilled and talented staff nurse with knowledge of surgical procedures, medical therapies, hospital equipments and the ability to provide extensive patient care, assist senior doctors during surgeries, maintain a healthy and safe hospital environment :
ER NURSE
- Works directly under physicians assisting the doctors in providing the best possible medical service to patients.
- Documents and compiles a patient history regarding medical complaints, surgeries, and prescription medications, collect information on current injuries, symptoms and evaluate the needs and concerns of the individual patient.
- Assists in administrating procedures as well as provide IV therapy, cleaning and bandaging wounds, administering medications or injections and contacting other staff members when necessary for other procedures.
WARD NURSE
- Observes all patients and record their observations in reports to patients' primary physicians.
- Administering medications, and checking medication dosages and patients' histories for possible interactions.
- Starts, maintains and discontinues intravenous lines for administration of fluids, blood or blood products and medications.
- Provides advice and emotional aid to patients' families and educate patients and the public on various medical conditions.
DR NURSE
- Assists the doctor with the delivery by providing medical information and managing equipment.
- Aids the mother by providing encouragement and calling out instructions during delivery.
- Monitors equipment that tracks the health of the fetus and mother which helps the doctor know how delivery is progressing.
- Ensures the necessary equipment sits ready and hands the instruments to the doctor when requested.
OR NURSE
- Prepares and maintains operating room for all surgical procedures.
- Establishes and utilizes a checklist to monitor the physical plan of the operating room and equipment for conformity to all national standards for ensuring safety for the patient and all personnel.
- Coordinates with other hospital units, which include recovery room, intensive care, obstetrics, and nursing units, on patients’ progress and any special equipment or supplies that will be needed for the patient returning from surgery.
SEMINARS AND TRAININGS ATTENDED
Date Topic/Course Title
March 16 – 21, 2009 First Aid Training and Basic Life Support
Held in Philippine National Red Cross, Quezon City
PROFESSIONAL QUALIFICATION
Nursing Licensure Exam Passer (NLE)
June 1 & 2, 2008
Held at National Teachers College, Manila, Philippines
EDUCATIONAL BACKGROUND
Education Level : Bachelor’s Degree
Education Field : Nursing
Course : Bachelor Science in Nursing
Inclusive Dates : June 2004 – March 2008
School/University : Our Lady of Fatima University
SPECIAL SKILLS
- Trained in Diagnostic Procedures (ECG, TMST, Holter monitoring), People skills, and Computer literate.

[Dr.Rahul Sahare]

Dr.RAHUL SAHARE
E-Mail : rahul_sahare AT yahoo.com

My Career Objective :

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.
Academic Education :
- 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.A.M.S. – 5 & 1/2 year degree), from :
Government Ayurveda medical college and Hospital, Jabalpur, m.p.
RDVV, Jabalpur University, India
Executive summary :
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
Job profile :
- 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. .
Academic Professional summary :
- 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.
Knowledge and Ability :
- 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
Computer skill :
- 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.
Conference & Seminars :
- 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)
Interests :
- Writing poem ( kavita )
- Dance
- Making hand crafts
- Interact with people
Extra curriculum :
- 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.
Date : DR.RAHUL SAHARE
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