SASHA SAAD ALI

Case Management:

• Timely and efficiently case management, took decisions on unjustified stays
• Stayed current on claims processing, medical terminology, and other procedures
• Weekly hospital visits and coordinating with chief service officer regarding patient's daily report
• Reviewed administrative guidelines whenever questions arose during the processing of claims
• Reviewed claims for accuracy before submitting for billing
• Based the payment or denials of medical claims upon well- established criteria for claims processing
• Created master spreadsheet to record procedures, denials and approvals
• Timely and efficiently case management, took decisions on unjustified stays

Inpatient Claims and Outpatient claims

• Claim Committee Member 2, finalized claims
• Assess OPD, hospital and Reimbursement claims
• Efficiently and effectively processed a large volume of medical claims on daily basis
• Reviewed coverage determinations investigated and evaluated claims and negotiated settlements
• Investigated claim and settlement deals and reviewed coverage determinations
• Reduced loss ratios through fair and prompt processing of claims
• Obtained all necessary information to complete proper evaluation of injury claims
• Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control
• Verifies patient insurance and Medicaid coverage for billing purposes

Approvals:

• Timely giving approvals for hospital admissions
• To provide the services and decide if the patient requires hospital admission and providing approvals according to the policy
• Declining unjustified hospital admissions.

Health Camps:

• Free medical health camps in peripheries where needy patients don't have access to hospitals.

• Medical health camps

• Disease awareness, so that the patients are more likely to take action to prevent it happening to them

Telemedicine:

• Reviewed patient vitals remotely by the help of the nurse, current complaints and case details to fully understand symptoms and accurately assess conditions.

• Prescribed medications to treat and prevent different illnesses.

• Recommended diagnostic and laboratory tests to determine underlying causes and symptoms.

• Provided emergent medical care and treatment for life-threatening injuries and illnesses.
• Educated patients and families on benefits of healthy diet and adequate exercise.
• Ordered and executed various tests, analyses, and diagnostic images to provide information on patient condition.
• Diagnosed and treated patients suffering from chronic conditions.