Sally Ahmed Wafik

Globemed Egypt

• Senior Managed Care & Disease Management OfficerFull Time

  Apr 2022 - Oct 2022 -6 months

  Egypt , Cairo

  • Job Details:GlobeMed Egypt logo GlobeMed EgyptGlobeMed Egypt 4 yrs 11 mos4 yrs 11 mos Senior Managed Care & Disease Management OfficerSenior Managed Care & Disease Management Officer Full-timeFull-time Sep 2022 - Present · 1 moSep 2022 - Present · 1 mo Cairo, EgyptCairo, Egypt - Responsible for management of cancer cases by working telephonically with members diagnosed with cancer, reviewing their protocols and working collaboratively with both the member and the providers to ensure evidence-based care is being provided. Also, coordinating either onsite or remote access to a Center of Excellence (COE) facility. - Responsible for management of chronic disease cases by reviewing the chronic medications of the members and conducting comprehensive assessment of the members' health to develop a collaborative care plan with the member. - Applying cost containment plans to both cancer and chronic cases, while maintaining the quality of care. - Responsible for the Patient Support Programs (PSP) process to maximize the use of the program in the members' benefits & maximize the cost containment strategy. - Preparing reports in a timely manner, per policy by collecting, analyzing, and summarizing activities and interventions along with treatments and savings achieved through the cost containment plans.
• Senior Fraud and Abuse OfficerFull Time

  Jul 2021 - Mar 2022 -8 months

  Egypt , Cairo

  • Job Details:- Detecting and looking for possible FWA trends. - Combining large amount of data and analysis into meaningful conclusions with root cause analysis and action plans. - Fraud detection and prevention in addition to generating recoveries. - Data mining and data analysis required for conducting investigations on provider claims. - Preparing comprehensive investigations reports and analysis, documenting all evidence obtained in investigations in order to substantiate meritorious claims to deny unjustified claims, to recover improper payments or to recommend action. - Managing queries from providers, insurance companies and insured members related to claims audit, evaluation, and admiration. - Collaborating and communicating internally with associated department (legal, finance, claims) within the company as well as externally with clients and providers.
• Fraud and Abuse/Managed Care Unit OfficerFull Time

  Jul 2020 - Aug 2021 -1 yr, 1 month

  Egypt , Cairo

  • Job Details:- Detecting and looking for possible FWA trends. - Combining large amount of data and analysis into meaningful conclusions with root cause analysis and action plans. - Fraud detection and prevention in addition to generating recoveries. - Data mining and data analysis required for conducting investigations on provider claims. - Preparing comprehensive investigations reports and analysis, documenting all evidence obtained in investigations in order to substantiate meritorious claims to deny unjustified claims, to recover improper payments or to recommend action. - Managing queries from providers, insurance companies and insured members related to claims audit, evaluation, and admiration. - Collaborating and communicating internally with associated department (legal, finance, claims) within the company as well as externally with clients and providers. - Participating in case management and SMO process.
• Senior Medication Management /PBM OfficerFull Time

  Mar 2019 - May 2020 -1 yr, 2 months

  Egypt , Cairo

  • Job Details:-Supporting the approvals team with their inquiries, and participating in creating an encouraging work environment. -Shift leader responsible for distribution of tasks and skills to the approvals team. -Granting approvals for requested medical services and reply with approval decision (approved or rejected) via E-mail or Fax. -Issuing the authorizations and approvals through the company's system. -Responsible for prior online approvals for medications, outpatient, dental and optical requests. -Issuing approvals for the chronic medication and adding or editing the chronic medicines on the chronic system. -Participating in the info-desk by answering inbound medical inquiries from the customer service and replying via CRM system. -Collect and process the information needed to fulfill medical insurance claims.
• PSD Authorization DoctorFull Time

  Nov 2017 - Feb 2019 -1 yr, 3 months

  Egypt , Cairo

  • Job Details:-Answering the pharmaceutical requests through the Email or fax. -Issuing the authorizations and approvals through the company's system. -Responsible for prior online approvals for medications, outpatient, dental and optical requests. -Collect and process the information needed to fulfill medical insurance claims.