Medical Insurance

Dr. SAHAR EL-RADI ABDEL GABBAR

Mobile: +316-*******

mail: ************@*******.***

PROFILE

A high performing coding certified professional (CPC –P) with over 9 years experience in Health care, insurance, medical billing, coding and claims management.

Highlights of Skills and Experience

Solid experience in medical terminologies, clinical settings, insurance schemes, medical billing and coding(ICD 9, ICD 10,HCPCS,CPT4,IR-DRG).

Solid experience in conducting physician's coding trainings, improving clinical documentation, auditing and standardizing guidelines as per the best medical practice .

Professional experience in claims medical evaluation and adjudication.

Excellent problem solving skills and good analytical thinking.

Good management and organizational skills.

Flexible and adapts to changes.

Excellent verbal and written communication skills.

Professional team leading skills and aim at team development and motivation.

Proficient computer skills: Excel, MS Office and MS Outlook.

EDUCATION

Certified professional coder –Payer (AAPC)

CPC-P ID # 01361290

The Sudan Medical Council (2006)

Permanent Full Registration

Bachelor degree of M.B.B.S in Medicine and Surgery

Ahfad University for Women, Sudan (2002)

General Certificate of Education Examination London- GCSE 1995

EMPLOYMENT HISTORY

MEDICAL ENCODING SUPERVISOR –( 08/2010 - PRESENT)

NATIONAL HEALTH INSURANCE COMPANY -DAMAN

Supervising three teams of doctors( total of 20 doctors). Ensuring accurate and consistent adjudication of claims/authorization requests to align with regulations, contractual agreements and coding rules.

Ensuring full adjudication of claims with respect to medical justification and standardized contracts together with reporting of providers trends in billing and escalation of fraud and abuse for further investigations and audit.

Auditing and reporting of high cost claims to managers and medical director.

• Generating monthly reports for high cost claims, analyzing them and discussing them with higher management.

• Coordinating and assisting in contractual issues with providers and assuring its implementations.

• Maintaining and building professional provider relations.Contributing to the generation of medical guidelines as per the international good medical practice.

• Negotiating with providers regarding reconciled claims based policies and procedures and targeting towards closing financial accounts on quarterly basis.

• Coordinating with medical field auditors to facilitate recovery cases.

• Responsible for conducting training sessions for the team members regarding the updated medical guidelines, adjudication guidelines and coding trainings .

•Supervising the teams' overall performance, monitoring their productivity and responsible for conducting yearly appraisals for staff.

• Conducting interviews for new hires in fairly and professional manner and thus contributing in the selection process of staff.

SENIOR MEDICAL REVIEW OFFICER-(09/2009 - 07/2010)

NATIONAL HEALTH INSURANCE COMPANY -DAMAN

Deputy of supervisor.

Medical auditing of processed claims and communicating errors to colleagues.

Medical evaluation and clinical review of claims.

Fully responsible for implementing all the different polices and their scope of coverage and general exclusions.

MEDICAL REVIEW OFFICER-(08/2007-09/2009)

NATIONAL HEALTH INSURANCE COMPANY -DAMAN

MEDICAL OFFICER - (03/06-12/2006)

ALRAJA PRIVATE HOSPITAL

MEDICAL OFFICER - (02/2005-02/2006)

SUDAN MILITARY HOSPITAL

INTERNSHIP- (01/2003-07/2004)

TRAININGS, PROFESSIONAL DEVELOPMENTS AND AWARDS

SAS Enterprise Guide Training for data analysis –February 2015

•Training in interviewing skills – February 2014

Training in leadership skills (Chosen among top 15 supervisors from among 40 supervisors -"Commands tasks" and" Gold of the Desert King" workshops) -April 2013

• CMEIs in billing guidelines for different medical guidelines - conducted by Daman. -2012 - 2013.

• CME in ICD10 Codes and its implementation -HAAD (February -2013)

• CME ''New 2011 CPT and ICD-9-CM codes'' -HAAD. (May 2012).

• Certificate Of Excellence for Passing DRG training course and test, conducted by AOK Consultants Team/ MSD Daman. (Jan 2011 - Feb 2011)

• CME in E&M inpatient codes and Outpatient codes - HAAD

• A certificate in supervisory skills 1 &2 (conducted by J.E.T consultancy, Ms. Joanna Thumiger). 2012

• A certificate in principles of Quality assurance. Daman 2009

• A certificate of “principles of health insurance” CII CPD accredited event by JWZ insurance solutions W.L.L. (November 2008)

• A certificate of “introduction to insurance” CII CPD accredited event by JWZ insurance solutions W.L.L. (June 2008)

• Award for "best clinical file” by the federal ministry of health in Sudan at the levels of all hospitals in Khartoum. (2003)

• Participated in the 10th Utrecht medical summer school in vascular medicine in Holland, being a member of the American Medical Student's Society. (1999)

Reference available upon request

Contact this candidate