Dr. Syed Muhammad Hassan Bukhari

·        Assessment of day-care and in-patient cases as per medical justification and policy coverage.

·        Escalated and confirmed grey-area cases. Confirming of exclusions of borderline cases OP/IP.

·        Assisted CC officers and supervisors in claims adjudication cases when needed

·        Sending request of confirmation and notification to corresponding payers as needed.

·        Responded well to payer's queries in relation to day-care and In-patient cases.

·        Monitored Claims cost as per internal guidelines.

·        Rejected medically unjustified and policy wise excluded day-care and in-patient cases to be signed by Chief Medical Officer.

·        Conformity of assessment for the prescribed tests/medications/investigations/clinical procedures.

·        Contacted provider for queries and clarifications.

·        Done clinical discussions directly with the network's doctor as needed.
- Seeking verbal clinical opinion from Network's doctor as needed.

·        Establishing strategies and implementing effective parameters for solving all possible queries within the team.

·        Entering and processing/ adjudicating claims in operational software system as per the terms and policy of the organization.

·        A Compassionate, Hardworking and Committed Doctor with 2-3 years of experience in practice.

·        A Client/Patient focused Medical Officer with dynamic personality holding positive, flexible and friendly attitude.

·        Management, Co-ordination and settlement of overall Medical Hospital Insurance Claims within the settlement authority.

·        Assessment and processing of Claims in line with the policy coverage and medical necessity.

·        Professional Experience and Outstanding Skills in Healthcare System.

·        Staying Up to date with client policy coverage.

·        Seeking Seniors opinion and expert guidance by getting in touch with them whenever needed.