Abdullah Syed Younus

Experience

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  Hamdard University Hospital

  May 2014 - Jul 2015

  Internship Trainee

  Academic Trainings• Offering educational assistance to medical and nursing students for the clinical teaching program in the field of education• Conducting tests, monitoring and assessing test results, and providing academic and advising support to students while they engage in educational tasks• Participating in the development, implementation, and maintenance of academic quality control strategies.• Provide students with information on extracurricular activities, possibilities for professional advancement, and course insights for improved academic results.• Contributing to the creation of the program's new curriculum and materials, which are currently deployed on an annual basis.• Coordinating with department heads, clinical competency project leaders, and other pertinent faculty members to organize, carry out, and assess educational programs.Clinical Sessions• I worked on a rotational basis in Medical, Surgical, A&E, pediatrics, O&G, Psychiatry, and Ophthalmology, ENT, and Dermatology departments, including the OR and ward for management of common medical conditions.• examined patients, documented their medical histories, ordered laboratory tests, and performed imaging and other diagnostic procedures under direct supervision.• performed minor surgical procedures and worked with a multidisciplinary team, including nurses and doctors.• carried out some medical procedures, including IV cannulation, ECG, ABG, ABPM, urinary catheterization, gastric lavage, eye-ear wash, and FB removal.• Accompanied registrars and consultants on morning and afternoon ward rounds and daily cases presentations. Show less

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  Red Sea Medical Centre

  Nov 2015 - Jun 2016

  Senior Medical Officer

  General PractitionerClinical:The role involves providing immediate medical care to patients with acute illnesses or injuries, conducting thorough assessments, prescribing medications, performing minor surgeries, ordering and interpreting diagnostic tests, collaborating with specialists, educating patients, documenting patient encounters, participating in quality improvement initiatives, and adhering to patient safety protocols and medical ethics.

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  Yanbu National Hospital

  Aug 2016 - Dec 2019

  Medical Claims Auditor - Physician

  General Practitioner/Medical Approvals Coordinator/Claims ReviewerKeys tasks.Administrative:1. Conducting thorough investigations and audits of claims to ensure adherence to billing guidelines and standards.2. Communicating audit findings and recommendations to relevant stakeholders, such as healthcare providers, insurance companies, and regulatory agencies.3. Collaborating with internal teams to resolve claim discrepancies and address billing issues.4. Developing and implementing strategies to improve claims processing efficiency and accuracy.5. Staying updated on changes in healthcare regulations, coding guidelines, and insurance policies.6. Reviewing medical treatment requests submitted by healthcare providers for pre-authorization.7. Assessing the medical necessity and appropriateness of requested procedures, treatments, and medications based on established guidelines and insurance policies.8. Verifying patient eligibility, coverage benefits, and insurance plan details to determine the level of authorization required.Clinical:1. Prescribing appropriate medications and treatments based on diagnosis and patient needs based on evidence-based medicine.2. Performing minor surgical procedures, such as suturing lacerations and draining abscesses.3. Ordering and interpreting laboratory tests, imaging studies, and other diagnostic procedures as needed for accurate diagnosis.4. Collaborating with specialists and other healthcare professionals for consultation and referral when necessary. Show less

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  Al Ansari Specialist Hospital

  Feb 2020 - Aug 2020

  Medical Claims Auditor - Physician

  SHO Medicine/General Practitioner/Medical Pre-Authorization Coordinator/Medical Claims Reviewer/Medical Claims AuditorKeys tasks.Administrative:1. Conducting thorough investigations and audits of claims to ensure adherence to billing guidelines and standards.2. Communicating audit findings and recommendations to relevant stakeholders, such as healthcare providers, insurance companies, and regulatory agencies.3. Collaborating with internal teams to resolve claim discrepancies and address billing issues.4. Developing and implementing strategies to improve claims processing efficiency and accuracy.5. Staying updated on changes in healthcare regulations, coding guidelines, and insurance policies.6. Reviewing medical treatment requests submitted by healthcare providers for pre-authorization.7. Assessing the medical necessity and appropriateness of requested procedures, treatments, and medications based on established guidelines and insurance policies.8. Verifying patient eligibility, coverage benefits, and insurance plan details to determine the level of authorization required.Clinical:1. Prescribing appropriate medications and treatments based on diagnosis and patient needs based on evidence-based medicine.2. Performing minor surgical procedures, such as suturing lacerations and draining abscesses.3. Ordering and interpreting laboratory tests, imaging studies, and other diagnostic procedures as needed for accurate diagnosis.4. Collaborating with specialists and other healthcare professionals for consultation and referral when necessary. Show less

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  Nahdi Medical Co.

  Sept 2020 - Sept 2023

  RCM - Medical Claims Auditor - Physician

  SHO Medicine/General Practitioner/Telemedicine physician/Medical Approvals Coordinator/Medical Claims AuditorKey tasks.Administrative:1. Review and analyze medical claims to ensure accuracy and compliance with insurance policies2. Verify patient information and insurance coverage details for claims processing3. Conduct audits of claims processes to identify areas for improvement and ensure adherence to regulatory requirements4. Communicate audit findings and recommendations to relevant stakeholders5. Collaborate with internal teams, such as claims processing and compliance, to address issues and implement solutions6. Develop strategies for improving claims processing efficiency and accuracy7. Stay updated on changes in regulatory requirements and insurance policies8. Successfully launched the on-spot telemedicine consultation project in collaboration between Nahdi Medical Company and IQVIA9. Improved patient satisfaction and clinical outcomes during the pandemic era10. Increased company profit by up to 70% through the implementation of telemedicine consultation services11. Reviewing medical treatment requests submitted by healthcare providers for pre-authorization.12. Assessing the medical necessity and appropriateness of requested procedures, treatments, and medications based on established guidelines and insurance policies.13. Verifying patient eligibility, coverage benefits, and insurance plan details to determine the level of authorization required.Clinical:1. Educating patients and their families about their medical conditions, treatment options, and preventive measures.2. Documenting patient encounters, medical histories, and treatment plans accurately and in compliance with regulatory standards.3. Participating in quality improvement initiatives and maintaining knowledge of best practices in urgent care medicine.4. Providing compassionate and efficient care while adhering to patient safety protocols and medical ethics. Show less