Experienced Medical Claims Revenue Cycle Manager
أرسل عرض عمل مباشرة لهذا المرشح
► I have worked under different titles in the medical insurance filed.
► My experience extends through pre-authorization, claims integrity, revenue cycle management.
► I co-founded an RCM and medical services company in Cairo-Egypt (C-Cure), in 2012.
► I am currently looking for job role where I can gain experience and utilise my skill
Mohd S. Al Khonaini Medical Complex, Jubail-KSA • Revenue Cycle Manager 10/2013 - Present
At the managerial level, I lead a team of medical billers, coders, and internal auditors. On monthly basis, I perform a trend exercise to spot the areas of defects and perform a root cause analysis to avoid further losses. In collaboration with the finance team, I perform a regular review of the pricelist and contract conditions according to the changes in the facility operation cost. We also cooperate in decision making in reconciliations. I was able to achieve:
► Claim maturity reduction from an average of 60 days to 7 days.
► Decrease in bill loss due to rejections from 27% to 8%.
► Covering additional networks and maintaining the revenue increment.
► Modification of the billing scheme to reduce missed billing of services.
► Establishing the fundamentals of value-based healthcare through monitoring “Cost to Outcome” per patient.
► Remarkable adherence to NPHIES standards in coding (Saudi Billing System) and different types of transactions.
C-Cure, Cairo-Egypt • Co-Founder and Executive Manager 06/2012 - 09/2013
As a group of three ambitious and experienced doctors in the field of medical insurance, we founded an RCM company that serves private clinics with OPD insurance claims as a third-party service. We also introduced the co-insurance concept in the insurance market for the first time to increase the sub limits of certain benefits.
► I took the responsibility of studying the market, planning the targeted services using S.M.A.R.T strategic approach and the project feasibility.
► As part of our service, we conduct insurance orientation sessions to the doctors.
► In the first 6 months, we established the first project and lunched the second phase which was the coinsurance plan.
As a result of the market turmoil during late 2013, our project could not revive from the Juvenile Death phase.
Egycare, Cairo-Egypt • Pre-Authorization Physician / Auditor 02/2010 - 04/2012
An entry level position where I was introduced to the fundamentals of medical insurance field. I have shown competency, resilience, and fast learning. Later, I was assigned as a medical auditor where I had to maintain the integrity of OPD and IP medical claims. My tasks included, but not limited to:
► Processing an average of 700 Pre-Authorization claims per 12 hours shift.
► Explaining the decision made according to the policy condition.
► Highlighting fraud indicators and conducting the relevant investigations.
► Monitoring the Best Medical Practice according to the local guidelines
M.B.B. Ch • Ain Shams University, Cairo-Egypt
Lean 6 Sigma Black Belt (in progres)
