Ivory Valle Email & Phone Number

Dubai, United Arab Emirates

Dubai, United Arab Emirates

Dubai, United Arab Emirates

Sharjah, United Arab Emirates

United Arab Emirates

TPA - Medical Insurance

Dubai Internet City

✓Handle complains, general inquiries and provide assistance to MedNet card holders, partner insurancecompanies, insurance brokers and healthcare provider via email and phone calls✓Coordinates with hospital/medical providers for verification to provide assistance to the member to resolve disputes/complains and follow up on customer issues requiring additional research✓ identify and escalate priority issues especially cases that requires reconsideration/re-assessment and… Show more ✓Handle complains, general inquiries and provide assistance to MedNet card holders, partner insurancecompanies, insurance brokers and healthcare provider via email and phone calls✓Coordinates with hospital/medical providers for verification to provide assistance to the member to resolve disputes/complains and follow up on customer issues requiring additional research✓ identify and escalate priority issues especially cases that requires reconsideration/re-assessment and miscalculation for reimbursement claims and denied pre-authorization request✓ Maintain call center turnaround times and ensure high quality of service is provided to the members,medical providers, PIC and brokers;✓ Works under general direction of the Team Leader MCC and liable to approve medical claims/ casesbetween AED 2,500 and AED 5,000/-as per on member’s eligibility and governing policy (HAAD regulations/DHA regulations/Northern Emirates/Bespoke policies and standard exclusions)- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process - Review and handle pre approval requests from healthcare providers and clients received by phone, e-mail and Fax - Report suspected fraud cases to supervisors✓ PBM authorizations under exceptional circumstances - Authorized to issue approvals through thePBM system up to a maximum of AED 3,000 per drug and a maximum of AED 5,000 for bulk drugsper member prescription✓ Maintain data confidentiality and reports pertaining to member information / medical cases on aweekly basis for future reference Show less

Dubai Emirate, United Arab Emirates

Codes ICD10 and CPT under the supervision of Certified Medical Coder prior submission to the insurance companies to ensure correct documentation and codes; Provides customer service (via telephone and email service) and gives information on the patient’s benefits, payables, possible exclusions and cost estimates prior admission/consultation; Responsible for the timely verification of medical insurance benefits, calling insurance companies, and obtain benefit information, determining… Show more Codes ICD10 and CPT under the supervision of Certified Medical Coder prior submission to the insurance companies to ensure correct documentation and codes; Provides customer service (via telephone and email service) and gives information on the patient’s benefits, payables, possible exclusions and cost estimates prior admission/consultation; Responsible for the timely verification of medical insurance benefits, calling insurance companies, and obtain benefit information, determining insurance compatibility with health-care provider programs, updating and refilling claims, coordinating with patients regarding their insurance benefits and medical providers programs, re-verifying existing patient insurance coverage, and determining limits/scope of the patient’s claims versus patient’s policy Obtain approval (OP and IP: verbal and written) by calling insurance companies and sending request via fax/email for coverage/eligibility of treatment for emergency procedures/admission/investigations to be done; Follow up on the extension of admitted patient/elective cases and submit necessary documents to facilitate approval for supporting procedures/admission-extension/treatment/investigations; Attends outside calls/incoming calls whether from patients, TPA or insurer for queries related to patients, approval/status of approval or insurance eligibility/benefits; Coordinates with Admission and Discharge office for patient’s approval concern upon admission and discharge to clarify/check the coverage/exclusion of the patients; Encodes approval status of Inpatient approvals/pending/finished, compiles and send the report to the HOD for reference; Ensures KPI for the insurance companies are up to date and are met in general; Performs other duty assigns such as office filing and documentation Show less

Al Ain, Abu Dhabi

 Greets visitors, patient and other guest that are coming to the hospital; Update the on call personnel regularly for emergency codes;  Telephone Operator - Attends to queries either by telephone, email or in person and transfer the call to relevant department;  Provide accurate details RE: hospital operations (clinic times, visiting hours, patient rights, etc.) Counsel patients for insurance coverage, policy, exclusions, deductibles and reimbursements(if applicable); … Show more  Greets visitors, patient and other guest that are coming to the hospital; Update the on call personnel regularly for emergency codes;  Telephone Operator - Attends to queries either by telephone, email or in person and transfer the call to relevant department;  Provide accurate details RE: hospital operations (clinic times, visiting hours, patient rights, etc.) Counsel patients for insurance coverage, policy, exclusions, deductibles and reimbursements(if applicable);  Bill and collect cash upon admission, discharge, generates cash summary and reports; Performs daily reconciliation of collection summary with cash remittance; Responsible for booking hospital meeting rooms and other hospital facility (pool, laptops, projector, etc) Handles internal & external complaints, queries, request and other patient related request; Handles & updates admission & room distribution, rooms requests, whether change of room or faulty equipment; Handles and records mail/parcel and distribute to the staff - managing outgoing/incoming mail, faxes and courier bookings; Ensure office filing systems are maintained and updated;  Responsible for safekeeping hospital keys; Knowledge of Outpatient & In-Patient Pre-Authorization Procedures; Ensures that the flow of information is maintained to insurance companies, doctors, patients and all other service providers.  Monitor the office stocks and replenish stocks as needed; Performs other duties assigned Show less

Responsibilities include checking the facility equipment; coordinating with other company for patient transfers/annual check up; submission of monthly report to the Marketing Director of the stocks, faulty equipment and other clinic issues that needs to be updated/replace/removed; and building customer relations to other companies inside the JAFZ. Other Duties assign but not limited to:oRegistration:- Screen calls and transfer calls appropriately; maintains a call log of all calls… Show more Responsibilities include checking the facility equipment; coordinating with other company for patient transfers/annual check up; submission of monthly report to the Marketing Director of the stocks, faulty equipment and other clinic issues that needs to be updated/replace/removed; and building customer relations to other companies inside the JAFZ. Other Duties assign but not limited to:oRegistration:- Screen calls and transfer calls appropriately; maintains a call log of all calls received and done (incoming & outgoing calls)- Greets and assists visitors and patients; obtains initial patient information, including demographic and insurance information; reviews and maintains patient data; performs time of service payment collection and posting.- Identifies issues/trends with payers; investigates and corrects errors; researches missing or incorrect account information; appropriately updates account activity, including accounts receivable invoices.- Maintains medical and insurance referral records; examines and resolves patient referral issues.- Resolves registration and claim edits and completes registration reports (differences, fatal, etc.) to accommodate processing of charge entry and claim submissions.- Works with internal department staff to ensure effective communication process with staff and constituencies external to the department.oCashier:- Receive and disburse money in establishments other than financial institutions.- Issue receipts, refunds, credits, or change due to customers; compute and record totals of transactions.- Establish or identify prices of services or admission, and tabulate bills using calculators, cash registers, or optical price scanners.- Calculate total payments received during a time period, and reconcile this with total sales- Compile and maintain non-monetary reports and records- Keep periodic balance sheets of amounts and numbers of transactions- Post charges against guests' or patients' accounts. Show less

• Provides online support/live help via chat, voice and email regarding documents & withdrawals restrictions • Respond to Client needs in timely manner• Responsibilities include but not limited to cash processing, compliance standards, APM reconciliation and customer support; • Brief new auditors and gives feedbacks/evaluation to immediate supervisor regarding improvements/progression of new auditors• reduce the possibility of a material misstatement, whether as false or… Show more • Provides online support/live help via chat, voice and email regarding documents & withdrawals restrictions • Respond to Client needs in timely manner• Responsibilities include but not limited to cash processing, compliance standards, APM reconciliation and customer support; • Brief new auditors and gives feedbacks/evaluation to immediate supervisor regarding improvements/progression of new auditors• reduce the possibility of a material misstatement, whether as false or missing information, whether caused by fraud (including deliberate misstatement) or error; • To compile a report to management regarding any important matters that came to the auditor’s attention during performance of the audit • To evaluate and review the audit evidence obtained (mostly documents), ensuring sufficient appropriate evidence was obtained for every material assertion • Safe keeping of these evidence • Performs account evaluation (deposit/withdrawal) Show less

Date Joined : Apr 2004 Date Left: October 2005Handles customer complaints, request and other billing inquiries; Handles acquisition of new telephone service/services and features;Responsible for switching call carriers (local calls, long distance, inter & intrastate calls, international calls);Identify calling patterns to promote proper calling plans; Make necessary bill adjustments; Responds to customer’s request for other improvements/changes on the… Show more Date Joined : Apr 2004 Date Left: October 2005Handles customer complaints, request and other billing inquiries; Handles acquisition of new telephone service/services and features;Responsible for switching call carriers (local calls, long distance, inter & intrastate calls, international calls);Identify calling patterns to promote proper calling plans; Make necessary bill adjustments; Responds to customer’s request for other improvements/changes on the account. Transfer calls to relevant department for Finance/Technical concern. Manages each customer interaction with utmost professionalism, courtesy, and responsiveness. Accountable for meeting and/or exceeding assigned sales objectives and monthly revenue quotas, maintaining existing and building new revenue by selling a select set of telecommunications products and services to medium size accounts. Provide prompt follow-up to all customer inquiries. Responsible for customer satisfaction goals Show less