Misbahuddin Ahmed Email & Phone Number

Dubai, Ae

Dubai, United Arab Emirates

Knowledge of business analysis concepts of defining requirements, translating to technical solutions, and Agile approach to prioritizing work to epics, sprintsBusiness analysis skills including facilitation, process documentation, requirements gathering and user acceptance testingGood organizational/time management skills to prioritize work and meet deadlines within defined timeframesFocus on Digitial transformation of assets and build relationships with the process owners and business functions by developing a communication process to keep up to date on initiative and project status.Strong understanding of AI/ML technologies and their applications in healthcareCollaborate with cross-functional teams, including engineering, AI/ML, design, marketing, and commercial, to deliver high-quality product featuresProvide guidance and support to the team and coordinate respective service activities and deliverables together.Elicit requirements using interviews, document analysis, requirements workshops, surveys, business process descriptions, use cases, scenarios, business analysis, and task and workflow analysis. Critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details, abstract up from low-level information to a general understanding, and distinguish user requests from the underlying true needs Proactively communicate and collaborate with external and internal customers to analyse information needs and functional requirements and deliver the following artefacts as needed: Business Requirements Document Screen and Interface designs Log initiatives in JIRA and Confluence and keep the status up to date. Create complex test case scenarios to be used in testing; monitor/oversee the testing of business applications to verify that all client requirements are incorporated into the system design. Support QA, UAT and Release phases of the project via defect analysis, change maintenance.

United Arab Emirates

As a RCM manager responsible for Payer Relation Management.Develop Value Cycle Management model to collaborate other departments to align KPI’s toAchieve better outcomes.Develop strategies and benchmarks for physician to achieve optimal Revenue focusing on value based healthcare model.RCM Department planning, resource allocation and on boarding.Develop and implement SOP’s for the department.Manage and Monitor physician average claim revenue to achieve optimal benchmarks andrevenue performance.Identify certain capacity and services from the SPC and enable to start billing missedopportunities.Manage physician case mix and unspecific assessments by trend analysis to bring more focus on missed billing opportunities.Manage front desk KPI’s for insurance registration and eligibility.Training to create SMART front office focusing more on patient experience to sustain.Manage Pre Approvals, Medical Coding and Billing.Team calibration and improvement to enhance productivity.Revenue Optimization by quality coding.Manage Audit layers to ensure quality submission and minimize denials at first cycle.Ensure submissions are complying with DOH regulation to be completed within 24hrs.Manage Denials Audit and resubmission allocations, Control rejections.Contract Management and unit pricing strategy.Charge Data Master ( Develop master data for HIS to align with each insurance company agreed CPT master for billing to improve billing accuracy)Update CDM as per new addition and deletion of codes. Monitor Physician ordering pattern to avoid credit collection disputes.Update Inclusion and exclusion rules to automate physician prescriptions to increase accuracy in billing.Financial Planning with Senior Management.Budget planning for the department.A/R Management, Reconciliation Management and Closures.Manage Reports for Revenue, Receivables and denials to present management.Support Management in Key strategic decision on business expansion.

Dubai, United Arab Emirates

Dubai, United Arab Emirates

Senior Operations Manager for RCM practice management to the below clients.1. SEHA Hospitals – Support Operations and Manage Medical Coding, Billing, denial Management, Physician Training (CCDI) services to client in Abu Dhabi region. .2. American Spine Center – DHCC: Manage and support client operations for RCM services, Manage day to day operations Inclusive of Authorization, Charge Captures, Medical Coding, Submission, resubmission of denied claims and reconciliation with certain proficiency commitment to achieve better cash flow. 3. Dr Sulaiman Al Habib Hospital – DHCC - (Managing Denial Management, CDI (Clinical documentation Improvement training for physician), Reconciliation for 2016 and 2017. 4. Nation Hospital – Abu Dhabi: Sr Operations Manager for Revenue Cycle Management services inclusive of RCM Training, CDI Program, Contract Management, Case Management and Authorization, Medical Coding, Claim Submission and Resubmission, Collection and Reconciliation.5. Al Zahra Private Hospital – Dubai: RCM services resubmission of denied claims and reconciliation with certain proficiency commitment to achieve better cash flow. Analyze denial patterns area wise for further improvement in revenue and decrease rejections.6. GHI (Gulf Healthcare International): RCM services inclusive of resubmission of denied claims of 5 medical centers, 5 Laboratories and 1 radiology center located in abu dhabi as well Dubai region. Analyze denial patterns area wise for further improvement in revenue and decrease rejections. Support to client for reconciliation of pending receivables.7. Eye Consultant – DHCC: Manage and support client operations for RCM services, Support finance department to enhance better outcomes and maintain payer relationship, Manage day to day operations Inclusive of Authorization, Charge Captures, Medical Coding, Submission, resubmission of denied claims and reconciliation with certain proficiency commitment to achieve better cash flow.

Dubai, United Arab Emirates

Implemented digital process for RCM by automation. Develop DRG business process and integrate to 3M grouper. Design and developed 3M data report with in existing HIS in order to generate CMI (Case Mix Index). Implemented eAuthorization business process with in HIS modules to enable automation and reduce turn around time and increase patient satisfaction.Implement full digital claim processing by automation which helps the organization achieve real time claim processing with minimum resources and increases the cash flow from payer, also help management to save cost of human resources.Support manager in controlling average claim for out patient which is a key tool for payer satisfaction.Present Management RCM , Compliance and denial reports.Support General Manager in yearly budgets by HR planning and business key strategies.Integrate medical necessity tools at physician level in order to indicate clinical documentation GAP's for coding and billing.Develop full digital practice management system (eAuthorization, Claims Pocessing and uploading to DHPO, electronic posting and settlement for AR, Resubmission cycle for denial management, contract management)

Dubai, United Arab Emirates

Manage and coaching resubmission team for denial management, policies and procedures of claims resubmission with digital process.• Managing resubmission of denial claims with the standard time frame as per policies and procedure of department.• Managing classification of denials and make the training to resubmission team. • Working closely with Insurance Approvals and Claims Submission Team.• Making sure that claim resubmissions are dealt with according to Insurance industry and DHA regulation.• Working on complex cases that need experience and specialist knowledge.• Maintaining quality and insurance service standards.• Managing claims resubmission on time according to insurance agreed contract.• Making reports and accurate information for reconciliation.• Submitting KPI’s (Key Performance Indicator) of resubmission quarterly to higher management.• Taking responsibility for the department’s productivity and targets.• Prepare collection and rejection report and submit to higher management with percentage of complete rejection.• Train staff for claims auditing and denial management.• Manage coding cross walks like ICD to CPT, CPT to CPT, ICD to HCPCS• Review denial reasons and audit the claims in order to generate justification for resubmission.• Categorize the resubmission type based on the audit.• Submit the audit report to finance team and generate the resubmission XML and upload to DHPO.• Design and develop PBM in existing pharmacy module.• Manage pharmacy team for taking online approvals with system.• Support pharmacy for system related technical bugs• The system guarantees money from insurance and reduces rejections to 0%.• Implemented policies and procedures for PBM in pharmacy department.• Train new pharmacist for PBM system.• Technical support to pharmacy round the clock 24/7.• Daily update dispense of pharmacy claims on real time basis.

Dubai, United Arab Emirates

PROJECTS IMPLEMENTED FOR RCM1. Automatic allocation (Claims tracking): Recently designed and launched automatic allocation for finance collection modules where all the invoices can be tracked with payment reference. This will enhance finance collection report where invoices can be identical with payments and denials automatically. This new collection module will boost reconciliation for fast track payment.2. Electronic Medical Record: Designed and implemented EMR for the physicians. GAP analysis to make user friendly system. Continuous training of physicians to use EMR and go paper less records. UAT's before going live. Trained individual physician with easy techniques to use system. Modules include Treatment summary includes vital signs as TRP charts values entered by nurses, Chief Complaints, History of Complaints, Past Medical History, Surgical History, Social History, Family History, Review of systems, Physical Examination, Allergies, Diagnosis, Diagnostic procedures includes LAB, IMAGING, Ultrasounds, Prescription, Investigation results.2. ePrescription: eRx integration to Dubai Health Authority portal in order to get eRx number approved by DHA. Physicians review for eAuthorization before giving prescription to patient for potential drug to drug interaction and contraindications to minimize the risk factors. Trained doctors for the Vidal guidelines of potential drugs indications. 3. eAuthorization (PBM): Successfully designed and implemented eAuthorization for hospital inhouse pharmacy system. The system generate electronic prior request and send to insurance payer systems to get electronic approval for the medicines on real time basis before dispensing to patients. 4. eClaim Management: Successfully designed and implemented eClaim processing for revenue cycle management. Trained all the billers about Current procedure terminology (CPT). Trained medical coders medical necessity, denial management, validations, business and processing rules of DHA portals.

Dubai

Revenue Cycle Management process development for providers, Eclaim Solutions for claim cycle, Training for providers and Payers / TPA's, RCM business rules development and support providers for eclaim processing, Financial claims tracking, Medical coding, Public updates on portal. CEED (Code edit engine of Dubai) reviews for medical necessity.

Abu Dhabi, United Arab Emirates

Electronic claims management for insurance.Very good knowledge of medical coding.Submission and resubmission of claims to medical insurance companies.Validate eclaims management with new upgrade as per HAAD circulars.Process remittance for rejections.EMR (Electronic Medical Record Management)Manage daily front desk operations.Support training in assigned Applications and Clinical workflow processes.Managing front office.Patient service management.Medical insurance management.Trouble shoots office systems.Provide implementation and Post Implementation application Support.Co ordinate and support validation and testing of Application builds, system updates and future processes.Participate in user training Activities.Trouble shoots office networking.TQM (Total Quality Management).Supports manager in key decision, training of staff.Assists in developing long-term investment strategies.Maintains accuracy in accountancy.Participates in the posting, balancing and reconciliation of the general ledger and subsidiary accounts.Examines all accounting transactions to ensure accuracy.Assists in the preparation, analysis and review of estimated revenues, reimbursements, expenditures, fund balances or other proprietary and budgetary accounts.Researches and analyzes transactions to resolve problems.Assists in the preparation of annual financial reports.Recommends or implements changes in accounting and auditing systems and procedures.Managing financial statements for the monthly invoices to insurancesMonitors current activities for compliance with the country's activities and department goals.Maintains detailed documentation of audit findings and procedures through the use of papers and audit files.Assists in monitoring various accounts, verifying availability of funds and classification of expendituresMaking purchase order for disposables and require medical equipment.

Hyderabad Area, India

Making admissionsTaking approvals from the TPAs (third party administration), Handling telephone calls, taking messages and directing to appropriate person.Organizing and booking appointments for consultation.Making confirmation for appointments with the patients.Scheduling the patients' for their investigations via hospital information system.Executing care to patient’s requirements.Directing patients to appropriate department.Providing necessary information to patient about health insurance policies.Maintaining proper documentation for taking approvals from health insurance companies.Checking and maintaining expiry dates of medical insurance policies for patients.Maintaining proper documentation with medical health insurance companies.Checking expiry dates and renewing licenses.Making credit invoices with required documents and sending to billing department. Making credit batch statements, maintaining medical records with quality standards.Participate in control infection programmes organized by hospital.Participate in bio-medical waste management program.