Medical Pre authorization specialist
Resume:
A highly analytical doctor with proven years of experience in
Medical Insurance sector; extremely motivated and a very keen individual with vast experience in Prior authorization; highly articulate and effective communicator; works well with individuals on all levels; distinguished as a team player, problem solver and a resourceful person; possesses good interpersonal skills and team interactions to work with a variety of professionals.
Job Objective
Looking for a steady position with an organization as a Pre- Approval Officer in Medical Claims/Approval. Prepared to remain long term with the right organization
Academic
Bachelor's degree in Medicine and surgery [MBBS] from GULF MEDICAL COLLEGE AJMAN, in the year 2008
Internship from Sheikh Khalifa Medical City Ajman Professional Experience:
1. Medical Claims/Approvals Doctor
Dubai Insurance Company, Al Rigga, Dubai
Nov 2016-Dec 2020
Process Pre-Authorization Requests: In-patient & Outpatient
Handled incoming member/broker emails for
ongoing/escalated IP&OP cases
Proactive communication with providers verbally and in writing regarding claim adjudication, medical necessity, coding discrepancies & overpricing.
Provide professional customer service
Experience in Case Management of complex/high
cases
Cost containment in Inpatient admissions ensuring tight medical adjudication.
PO BOX 5414, DUBAI, UAE
CONTACT: +971-****-*****
E-MAIL adkjwh@r.postjobfree.com
Skill Highlights
Driven and Determined
Good communication skills,
both written and verbal
Good interpersonal skill
Extensive medical terminology
knowledge
Knowledge of CPT codes, ICD-
9 and ICD-10
Thorough knowledge of
Healthcare industry
Excellent Customer Service
Judgement & Decision making
Languages
English
Malayalam
Hindi / Urdu
Dr. Bijina Abdul Majeed
Knowledge of 3M and application of DRG
Medical review of reimbursement claims
Medical Auditing & Reconciliations
Decision making/Leading the team in addition to or in the
Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives
Lead the team in the absence of supervisor
Perform additional duties as assigned by management
Thorough knowledge about internationally approved management guidelines of various diseases and
conditions (AHA/NICE etc)
2. Doctor / General Practitioner (as locum observer) MES Hospital, Paravanna, India
Sep 2008 – Mar 2015
Working in a busy community medical care center providing primary medical care to patients from the local community by way of clinics and home visits.
Working in assistance with Chief Medical Officer as an Observer
Investigating and diagnosing sick and injured patients on their ailments and then arranging appropriate
treatments for them.
Updating and maintaining accurate patient records.
Advising patients on health education matters.
Supervising other administrative and junior healthcare staff.
Learning about the medical history of a patient to ensure they have no allergies etc.
If necessary referring patients to hospitals or specialist clinics for further investigation.
Planning staffing duties and rota's for medical staff.
Involved in the day to day running the practice.
Organizing specialist clinics for pregnant mother, diabetes, health eating etc.
Examining patients physically and doing so taking cultural and social sensitivities into consideration.
staff.
Giving appropriate health education and advice to patients and carers' to enable self-management.
Ensuring co-ordination and delivery of all work activities within area of responsibility
Personal Details
Name:
Dr. Bijina Abdul Majeed
Address:
VILLA 33, 34 B STREET, MUHAISNAH
3,PO.BOX5414,
DUBAI, UAE
Telephone number:
Mobile number:
Email address:
adkjwh@r.postjobfree.com
DOB:
16/08/1983
Marital Status:
Married
Citizenship:
Indian
Passport No:
S 8735592
Contact this candidate