Hadil Helaly , ECBA™

Experience

• 

  El Ezaby Pharmacy

  Oct 2013 - Nov 2014

  Customer Service Agent -Medical
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  Fahmy Pharmacy

  Jan 2015 - Oct 2015

  Community Pharmacist
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  GlobeMed Egypt

  Oct 2015 - Mar 2018

  Along with the below responsibilities as an outpatient adjuster.Responsibilities:1- Quality tracking for processors (Processing details on system) and auditors'claims daily.2- Training for Colleagues on system updates or any new operational instructions.3- Analysis for deductions from insurance companies and preparing replies for eachdeducted claim from their side.4- Checking all the pending and returned batches either Inpatient or Outpatient and sending them to the Network team, with their returned reasons for their communication with providers.5- Managing the segregation and the dispatching reported issues. Show less 1- Claims Processing & Auditing all provider types (Pharmacy, Dental, Hospital, Optical, Ambulatory (Laboratory and Radiology).2- Auditing huge number of claims and providers such as El Ezaby provider . Claimssubmitted monthly ranging 30000 40000 claim3- Reconciling deductions reports with Ezaby provider.4- Supported in processing of inpatient claims.5- Pool Management for policies.6- Training new comers/colleagues on claims workflow cycle.7- Analysis for deductions from insurance companies and preparing replies for eachdeducted claim from their side. Show less

  • Senior Claims Adjuster Quality Assurance

    Jul 2017 - Mar 2018

  • Claims Outpatient Adjuster

    Oct 2015 - Jul 2017
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  Assure Finance

  Mar 2018 - Nov 2019

  Business Analyst

  1- Gathering clients’ requirements for customizing their TPA IT solution system.2- Analyzing each requirement and preparing business requirement documents on how the process will be developed on system with all validations required.3- Testing each function on the platform and reporting any defect if any appeared.4- Training to the clients on their TPA IT solution for all departments (Underwriting, Chronic, Pharmacy Benefit Management, Approvals, Claims)5- Handling User Acceptance Tests (UAT).6- Supporting in running a full business cycle testing in other projects IT solutioneither TPA or Insurance Company.7- Adjusting the database codes and rules (Coding and mapping) to meet the clientrequirement and achieve control of fraud and misuse of provider claims. Show less

• 

  Amiral Management Corporation

  Dec 2019 - Apr 2021

  SAP IS-H med consultant

  1- System knowledge of standard SAP ISH Med module medication cycle2- Preparation of implementation and testing full cycle of SAP ISH Med Medications module (Outpatient pharmacy, Inpatient and clinical pharmacy ) as per collected blueprints3- Building drug catalog (standard and compounded4- Customizing templates as per physician user or specialty for easier medicationorders.5- Assignment of drug hierarchy.

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  Ecaresoft

  May 2021 - Nov 2022

  Clinical implementation consultant
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  Dedalus

  Nov 2022 - now

  Product Owner