Yasser Attia

- Overseeing the claims process by managing a team of claims processors, monitoring claim volumes, and ensuring compliance with industry standards.
- Managing insurance policies by communicating with insurance providers, negotiating policy terms, and ensuring that policies are up-to-date and comply with regulations.
- Reviewing medical records to ensure that claims are accurate and justified. I work with medical professionals to obtain additional information, review coding and billing practices, and ensure that claims are compliant with all relevant laws and regulations.
- Investigating claims to determine their validity. This involves reviewing medical records.

- Analyzing data to identify trends and areas for improvement. I develop reports, identify areas for cost savings, and work with other teams to implement changes.

- Conducting root cause analysis to determine the reasons behind rejection and classification, developing effective solutions for medical or technical rejections, and implementing policies and procedures to prevent any potential rejections in the future.

• Review and analyze medical service activities and data in order to support planning and risk management and to improve service utilization.
• Managed over 35 Employees, and increased their performance with percentage 20%
• Plan and direct operations of Medical Approval Team in accordance with department objectives.
• Responsible for implementing NPHIES system and solving all technical and medical problems with related departments for outpatient and inpatient approvals
• Ensure that medical cases and customers' queries are solved in accordance with Company quality standards in order to reach customer medical necessity and satisfaction.
• Cascade Company objectives to team leaders, ensure proper communication on new projects and new services; facilitate workflow between Medical Approval Department and all other departments.
• Prepare monthly statistical reports to VP Medical related to department operation, budget and cost containment, customer and provider complaints and medical cases.
• Report regularly team’s performance to VP Medical.
• Appoint Team Leaders, assign responsibilities, set objectives and assess their performance to measure achievements against these objectives
• Coach, develop and guide Team Leaders.
• Ensure that Company core competencies, values, and policies are implemented across Department teams.
• Miscellaneous tasks within scope of work, as assigned by direct manager.

• Act as point of contact for all approval requests for internal and external patients with all insurance companies, and resolve issues related to rejected and pending approvals, and ensure fast service.
• Ensure that patient insurance policy is eligible and covers required treatment, stay, or operations to avoid rejections.
• Ensure delivery of best-in-class service for patients, provide clarification regarding policy, medical rejection, pending requests to contribute to patients' satisfaction and overall SGH image.
• Review all patients' requests related to medical and pharmaceutical, diagnosis, and ensure that insurance policy covers them.
• Ensure following CCHI, SFDA protocol, policies and procedures when executing insurance activities.
• Ensure documentation of all approval activities to ensure accuracy and completeness of working papers, analysis and results to support findings and recommendations.
• Ensure uploading ' Table of Benefits' in hospital system for IN/OUT patient, with accuracy of patient deductible, approval limit, service inclusions/exclusions, and ensure all contracts/policies are assigned to correct price.
• Review and submit all approvals on time.
• Provide insurance companies with requests on time and getting approvals from them also follow up all pending requests.
• Commit with submitting all requests in due time
• Coordinate between insurance companies and hospitals in case of emergencies to deliver service to patients and then get Approval in allowed time "within 24 hrs. of admission".
• Confirm and analyze insurance patients' data with submitted data to avoid any confusion, fraud, or rejection.

- Established medical approval team

- Performed scheduled performance analysis to increase team performance

- Managed over 150 requests per day

- Increased approval efficacy by 10%

- Decision on high cost and complicated cases.

- International Pre-authorization.
- Attending calls and e-mails from insurance companies, clients and providers.
- Monitoring output.

Resident doctor, practicing medicine as a pediatrician.

- Evaluating claims with regards to eligibility.

- Managed over 180 requests per day
- Decision on high cost and complicated cases.
- Pre-Authorization