Regional Manager

Dr. Mohini Bharti

Mobile: 009*********** E-mail: ************@*****.***

Service-focussed professional with expertise in Operations, Revenue and Medical Claims Management driving organizational growth and profitability

Operations Management

Client Relationship Mgmt.

Customer Service Operations

Medical Claims Management

Revenue Cycle Management

Cost Containment/ Utilization

Prior Approvals Management

Network Management

Audit Management

Budget Management

Product Development

Regulatory Compliance

DRG Coding and Billing

Complaint Management

Energetic, Solution-focused Strategist, healthcare professional, offering several years of expertise in Operations, Revenue and Medical Claims Management across Hospital

& Insurance sectors

Contributed in the initial setup of Daman- the pioneer in Health Insurance in the UAE, Team Leader for automation project and Manager for Daman Qatar

Strong grasp of a variety of claim processing rules, benefit plans, guidelines and policy interpretations

Managed a wide variety of customer service and administrative tasks to resolve customer issues quickly & efficiently while adhering to the SLA

Delivered results in growth, revenue, operational performance and profitability; built strong rapport with patients through customer centric approach

Experience in business continuity planning, business transformation, business process reengineering, continuous process enhancement and implementing best practices across processes

Excellent track record of scrutinizing and finalizing medical bills claimed by the hospitals within stipulated TAT of mutual contract and as per coding guidelines

Holding strong contacts with large network such as leading hospitals & insurance companies

An effective leader with excellent communication, training, negotiation and relationship building skills

Since Jun’16: Mediclinic Al Noor Hospital as Regional Manager-Revenue Cycle Management Role:

Managing submission, re-submission, re-conciliation of claims within the set timeline along with proper screening of the claims as per DOH/DHA and coding/insurance guidelines

Facilitating recruitment, training and development of coders/other staff as per the policy and procedure

Creating internal guidelines and scheduling regular meetings with various departments / physicians

Administering work-load distribution, monitoring performance/KPI based on quality, target, audit, compliance with the regulatory guidelines and taking corrective action

Evaluating daily revenue reports and preparing various analytical reports as required by the higher management

Preparing department budget and plans for business growth

Conducting audits, minimizing recovery & outstanding, performing rejection analysis and meeting/ discussing with the insurance companies/DOH/DHA

Ensuring to follow best clinical practices, administering complaint management and client satisfaction

Investigating and resolving customer inquiries and concerns in a timely and empathetic manner Highlights:

Launched various system enhancements and process changes, which led to clearing the backlog and increasing the claims submission from 56% to 100%

Improved claim quality with minimum error rate; reduced from 22% to 2%

Attained score for Tasneef Audit >90% for the last 3 years consecutively Profile Summary

Work Experience

Key Skills

Benchmarks

Mar’13 – April’16: Abu Dhabi National Insurance Company as Manager- Medical Claims and Authorization Highlights:

Introduced enhancement processes within the department – paperless authorization, 24/7 management of authorization/ call centre department, automation of claims and mobile applications

Initiated the setup of the Medical Investigation and Audit Department of ADNIC for detecting fraud and abuse

Worked as Network Manager- managed network expansion, empanelment, price negotiation, contracts and met the requirements of DOH/ DHA

Conducted live and post-paid audits of the providers after analyzing the trends and suspicion of fraud/ abuse, random audit, met & implemented recoveries based on the findings, intimated the regulatory bodies, if necessary Jun’06 – Mar’13: National Health Insurance Company as Deputy Manager / Supervisor - Medical Authorization Highlights:

Contributed in the initial set up of the department; facilitated as Team Leader for automation project and the Qatar Project

Recognized as Medical Manager for Daman Qatar

Attended trainings on various topics such as Supervisory Skills, Team Building, Coding Guidelines, Performance Management, Innovation Workshop, Project Management Sep’02 – Mar’06: Al Dhafra Insurance Company as Medical Insurance Officer Highlights:

Maintained the loss-ratio in control by strict and fair management of claims to the entire satisfaction of seniors

Attained 6 new reputed clients to get insured with the company

Represented the company in all national & international seminars, continued medical education and health awareness programmes

Independently managed medical claims for various clients on direct billing basis (reviewing of claims, checking its authenticity, rejecting unjustified claims, checking the limits under the policy and final processing)

Project Management

Performance Management

Budget Management

Time Management

Team Management

DRG & Coding

MD (Internal Medicine) from Crimea State Medical University, Symferopol

Proficient in MS Office, Mednext, MIMS, TASCH, HIS, ERP, SAP IT Skills

Previous Work Experience

Education

Certifications and Trainings

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