MOHAMED's CV
MOHAMED ADEL MOHAMED FOUAD
Eligibility, Insurance Verification & Pre-Authorization Officer
Profile summary
Dedicated eligibility, insurance verification, and pre-authorization officer with 4 years of experience across 2 organizations in the UAE. Skilled in insurance verification, medical necessity review, and regulatory compliance within the healthcare sector. Committed to maintaining data accuracy, supporting seamless patient flow, and ensuring adherence to DHA standards.
Career highlights
Insurance Eligibility and Registration: Verified patient insurance eligibility, confirmed coverage, and completed patient registration for 90 to 100 patients daily using the Yassi HIS system.
Pre-Authorization and Payer Review: Reviewed submitted medical documentation for medical necessity and processed pre-authorization requests for 100 to 120 patient interactions daily at Medcare Hospitals.
Billing Reconciliation and Compliance: Processed billing entries and patient payments, reconciling transactions at the end of shifts with zero discrepancies while adhering to DHA regulations.
Professional Coding Certification: Maintained professional development through the Certified Professional Coder credential from AAPC with an exam target of December 2026.
Key skills
Professional experience
Manages patient experience operations within a hospital environment, overseeing eligibility checks, registration workflows, billing reconciliations, and administrative support across rotating shifts to maintain continuous patient flow and regulatory compliance.
- Completes accurate patient registration and ID verification for 90 to 100 patients daily, ensuring data integrity for downstream billing and compliance reporting.
- Reconciles payment transactions at end of shift with zero discrepancies while processing daily billing entries.
- Collects required signatures and distributes patient rights documentation to keep every visit compliant with healthcare regulations.
- Reviews submitted medical documentation for medical necessity and compliance with payer policy prior to approval.
- Tracks and follows up on outstanding eligibility, documentation, and pre-authorization items across departments.
Executed administrative and patient support operations as Customer Service Executive at Medcare Hospitals & Medical Centres in the UAE, overseeing daily processing of insurance eligibility, pre-authorization requests, billing transactions, and medical records across phone, email, and in-person channels.
- Handled patient, insurance, and medical-record inquiries across phone, email, and in person with fast, professional turnaround.
- Took ownership of patient and documentation issues end-to-end via Tracker and Voice of Action, escalating only when a case needed it.
- Balanced and reconciled cash and billing transactions, supporting the clinic deposit process without discrepancies.
Education
Management Information Systems
Certifications
Languages
Arabic · Native
English · Fluent