Anan Salem
Dammam,Saudi Arabia
Summary
Accomplished professional with extensive expertise in project planning and program delivery, business development, and financial analysis. Demonstrates strong skills in teamwork and team building, data management and analysis, and customer service management. Proven track record in service delivery management, collaborative problem solving, and quality control and assurance. Adept at applying generally accepted accounting principles (GAAP) to ensure accurate financial performance. Excellent presentation skills, critical thinking abilities, and interpersonal communication. Committed to driving business strategy and requirements while excelling in sales operations and change management.
Overview
30
30
years of professional experience
2030
2030
years of post-secondary education
1
1
Certification
Work history
RCM & Business Development Manager
Procare-Riaya Hospital
Al Khobar
2023.12 - 2025.08
- Under my observation:
- Key Achievements:
- 1- Revenue Cycle Management (RCM): Streamlined RCM processes, ensuring efficient claims submission, approval, coding, insurance management, and collections, leading to improved revenue and reduced denials.
- 2- Business Development: Successfully expanded the hospital's service offerings through strategic partnerships and new business ventures, contributing to increased revenue and market share.
- Responsibilities:
- Revenue Cycle Management (RCM):
- 1. Claims Management:
- A. Ensured timely submission and review of claims through NPHIES.
- B. Provided technical solutions for Jason file-related issues.
- C. Verified contract pricing, terms, and conditions.
- D. Managed MOH and GOSI submissions.
- 2. Approvals:
- A. Handled outpatient and inpatient approvals for direct, insurance, GOSI, ARAMCO, and MOH.
- B. Care & Case Management.
- 3. Policy Coding:
- A. Created new codes and pricing.
- B. Maintained updated MOH price lists.
- C. Control IDF policies with generic and brand codes.
- 4. Insurance:
- A. Audited claims (in and out).
- B. Facilitated communication for adding new services.
- C. Responded to complaints.
- D. Rejection and rework.
- E. Manage and control NPR (No Pre-authorization Required)
- 5. Collections, Rejections, and Reconciling:
- A. Followed up on GSS reports and submitted VAT invoices.
- B. Ensured timely monthly collections (prompt and regular payments).
- C. Managed direct accounts, MOH, and ARAMCO payments and collections.
- D. Follow and reconcile outstanding payments with all insurance companies.
- 6. Admission and Discharge:
- A. Arranged admission plans.
- B. Followed up with patients and approval offices.
- C. Coordinated with third parties.
- D. Prepared inpatient invoices.
- E. Managed outstanding amounts.
- F. Submitted invoices daily for medical auditing and credit contract adherence.
- 7. Patient Engagement/ Call Center/Patient Relation/ Duty Managers:
- A. Frontline staff (receptionists).
- B. Policies Setup.
- C. Special Discounts/offers.
- D. Patient submitted invoices daily for medical auditing and credit contract adherence.
- 8. Medical Records:
- A. Activation and support of electronic files 100%.
- B. Manage orders with support documents.
- C. Follow-up electronic and digital attachments.
- Business Development:
- 1- Third-Party Partnerships:
- A. Negotiated and secured new contracts with medical centers.
- B. Managed contract renewals and collections.
- 2- New Business Opportunities:
- A. Identified and pursued new business opportunities within ProCare umbrella.
- B. Conducted feasibility studies and collaborated with finance to create new agreements.
- C. Successfully launched new projects, including the Cath Lab, Dental, Ophthalmology, and Kitchen.
- D. New business with insurance companies, referral track, special services, etc.
- 3- Marketing:
- A. Overseered social media management and controlled Procare's online identity.
- B. Managed external events in collaboration with the hospital.
- C. Executed successful marketing campaigns, such as donation events, Psychiatric Day, and Tikyat-Bahar.
- D. Conducted market research and analysis to inform marketing strategies.
- E. Managed special campaigns for some services or events with the hospital
- Negotiated sharing percentages and managed monthly statements.
RCM - Business Analyst Manager
GAMA Hospital
Al Khobar
2021.10 - 2023.10
- Under my observation:
- 1- Main Price List: Analyze the price list and provide a complete comprehensive price list that covers all current services at Gama Hospital
- 2- Mapping with NAPHIS according to root services and CCHI BS codes
- 3- Contracts with insurance companies: revising the contracted service list, revising the agreed discounts and special benefits for each company, and making sure that the system is reading from the agreed contracted price list
- 4- Study and analyze the service cycle: from the reception through the doctor’s clinics and approval until to the billing. Taking into consideration checking the best practice of utilizing the system features that help to enhance the quality of outcomes for all the cycles.
- 5- Redefining services to match the requirements of each cost/profit center.
- 6- Meet and visit concerned departments to evaluate their practice on how to order and deliver the services ( service, medication, and PD)
- 7- Make sure that our medical guidelines are linked to the Price List properly (defining and justifying medical procedures, which is becoming service at the end)
- 8- Reviewing the process of under-limit transactions that haven’t been seen by the business center and comparing them with the mapped price list ( Naphis, Approval process).
- 9- Revising the invalid codes with Nphies and correcting its process to avoid technical rejection
- 10- Re-evaluate package services and their setup on the system and make sure that the concerned staff (IN/OUT) is implementing it correctly
- 12- Collaborate with Quality, IT, Operations, Insurance, and Billing teams to establish CHI & RCM certificate
RCM - Billing Manager (cash and credit)
Procare-Riaya Hospital
Al Khobar
2015.06 - 2021.06
- Under my observation:
- 1. A member of the NAPHIS committee for mapping codes and implementation.
- 2. Doing mapping for Naphis between ProCare codes & CCHI-BS codes and ADA codes.
- 3. A member of the ARAMCO committee during negotiations to have an agreement.
- 4. Coding, I am a member of the ARAMCO Steering Committee and am responsible for having mapped our codes and their codes.
- 5. A member of the VAT implementation team (credit & cash) with the FIDUCIAM VAT consultant and final submission to GAZT.
- 6. I am a member of the reconciliation team with all insurance and direct companies.
- 7. Prepare reconciliation (monthly, quarterly & annually) based on rejection and required reports.
- 8. I am a member of the committee to evaluate and
- 9. I was ahead of the committee on coding for fixed assets during the establishment of a hospital, and implementing with IT a module of asset controllers.
- 10. A member of the inventory items controller (pharmacy, consumables, and other items related to medical services) includes pricing and sales flow charts.
- 11. A member of the internal audit team (income, inventory, and cost):
- A. Prepare a flow chart of sub-stores and control items (medical, especially) and pricing.
- B. Reimbursement items through the patient file and under each specific department's control.
- 12. I am a member of the team at the established hospital and the chart of accounts.
- A. Cash & credit revenue.
- B. Account receivable and rejection.
- C. Inventory items and fixed assets.
- D. Betty cash for operation departments (cashiers of reception and admission & discharge officers).
- 13. Handled financial analysis and reporting of the billing revenue cycle and practice operations & direct companies.
- A. Prepare claims monthly and early submission
- B. Follow up attachments and required documents with the billing staff.
- C. Review necessary action to take to improve the flowchart of documentation.
- D. Use E-claim, soft copy, and hard copy.
- 14. Overhauled policies and procedures to eliminate gaps and standardized processes.
- A. Set up of credit contract
- B. Adding new service or package
- C. Setup of packages
- D. Costing (service, package, and credit contract)
- E. Review/supervise credit contract (new or old).
- F. Control closing and opening a new credit account.
- G. Control policy setup (cash & credit)
- 15. Technical Rejection:
- A. Resubmission
- B. Justify the rejection
- C. Share insurance dept. with reconciliation.
- D. Review all technical rejections and update the system
- 16. Discharge office
- A. Review, update, and improve inpatient invoicing (cash and credit)
- B. Follow-up collection and refund of the inpatient.
- C. Audit the operation of charging services during admission through the IT system and service department.
- 17. Revenue Auditor
- A. In & Out (cash & credit)
- B. Charge all missing services/find deficiencies and allocate.
- C. Training receptionists & nurses to eliminate any revenue deficiencies.
- 18. Cost accounting: I was a member of the costing committee to analyze the most common services and packages, even for doctors (regular and sharing).
- 19. Cancellation policy: to finalize cash and credit revenue daily for each cashier, to control daily revenue, and to avoid any mistakes.
- 20. Networking: a strong relationship with all insurance companies and similar hospitals.
- 21. Reduced waiting time for insurance reimbursement: Having conducted a needs gap analysis, developed, implemented, and encashed early submission.
RCM - Revenue Cycle Manager
Mohammad Dossary Hospital
Al Khobar
2011.08 - 2014.04
- (1) Cost accounting
- (2) Provider Data Management.
- (3) Provider & Hospital Contract Configuration.
- (4) Member Benefit Configuration.
- (5) Medical Billing.
- (6) Coding
- (7) Regulatory Reporting
- (8) CCHI Compliance
- (9) Credentialing & Vendor Delegation
- (10) Claim Processing
- (11) Staff Development & Team Building – Billing staff
- (12) Process Improvement
- (13) Internal Revenue Auditing
RCM - Billing Manager
Procare-Riaya Hospital
Al Khobar
2008.01 - 2011.01
- (1) Enable the Billing Modules for out, Inpatient & Claim.
- (2) Enable the Fixed Assets module.
- (3) Enable the consumables and medical inventories (Main and Sub stores) module.
- (4) Implements Price List of Services & Package Deal of Operation.
- (5) Billing on monthly basis with a statement of account, confirmations for major accounts.
- (6) Finalizing all settlements for major clients. (Clients rejection, medical claims, A/C receivable payments) & doing reconciliation.
- (7) Follow up and improve documentation & attachments monthly cycle with high-performance standards.
- (8) Follow-up collection.
- (9) Checking and justifying the monthly rejection of insurance co.
- (10) Reviewing the credit contract of the new client.
- (11) Member in any committee-related work with the invoice (cash or credit).
- (12) Cost centers controller
Medical Billing Supervisor
Al-Mouwasat Hospital
Qateef
2006.07 - 2007.05
- (1) This hospital merge with the previous Gulf Specialized Hospital
- (2) Billing on monthly basis with a statement of account, confirmations for major accounts (Aramco, Gosi, and Medical Insurance Companies) & directory – like Saudi Arabian Airlines.
- (3) Finalizing of all settlements for major clients. (Clients rejection, medical claims, A/C receivable payments).
- (4) Follow up and improve documentation & attachments monthly cycle with high-performance standards.
Medical Insurance Billing Supervisor
Gulf Specialized Hospital
Qateef
2004.07 - 2006.06
- (1) Billing on monthly basis with a statement of account, confirmations for major accounts (ARAMCO, GOSI, and Medical Insurance Companies) & directory – like Saudi Arabian Airlines.
- (2) Finalizing of all settlements for major clients. (Clients rejection, medical claims, A/C receivable payments).
- (3) Follow up and improve documentation & attachments monthly cycle with high-performance standards.
Finance Department Coordinator
Mohammed Al Dossary Hospital
Al Khobar
2003.02 - 2004.06
- (1) Designing and analyzing software for all finance departments and implementing charts of accounts.
- (2) Taking care of the finance flow chart, which will meet the administration and marketing goals of the hospital management.
- (3) Preparation of services, operations package deal, and price list.
- (4) Credit analysis study & follow-up of all major credit contracts.
Patient Account Supervisor
Tadawi General Hospital
Al Dammam
1995.05 - 2002.01
- (1) Managing all patients in & out.
- (2) Services and all package pricing.
- (3) Financial rejection settlements.
- (4) Administrate all services provided outside the hospital to the patient by other medical organizations.
- (5) Documentations Flow Chart improvement.
- (6) Providing internal audit practice for clinics, support departments & others.
Education
Doctor of Business Administration (DBA) - Business & Admistration
UCAM
Guadalupe12.2025
MBA - Accounting and Finance
UCAM
Guadalupe06.2021
Bachelor's Degree - Accounting (Major) / Business Administration (Minor)
Jordanian University
Amman, Jordan 1989.09 - 1993.05
Skills
- Project planning and program delivery
- Business development
- Teamwork and team building
- Data management and analysis
- Customer service management
- Financial analysis and performance
- Service delivery management
- Collaborative problem solving
- Presentation skills
- Critical thinking
- Generally accepted accounting principles (GAAP)
- Sales operations
- Change management
- Interpersonal communication
- Business strategy and requirements
- Quality control and assurance
Certification
- DRG Certified: Funding Model Healthcare & Quality (NAWA)
- RCM Certified: Princess Nourah University & SELAT
- Healthcare Quality Suite (AIHQ):
- Certified Patient Safety Officer (CPSO)
- Certified Healthcare Quality (CHQ)
- Certified in Healthcare Risk Management (CHRM)
Technical Skills & Languages
Languages: Arabic (Native), English (Fluent).
Accomplishments
- Technical Rejection Control: Successfully reduced rejections from 38% to 0% for Inpatient and 8-10% for Outpatient through rigorous contract control.
- Electronic Transformation: Headed the task force for 100% activation of electronic medical files, aligning with CHI and NPHIES requirements.
- Capability Building: Trained 260+ individuals in leadership and communication through Toastmasters programs.
Core Competencies (Aligned to Bupa Arabia)
- Service & TPA Management: Expert in overseeing medical care units to ensure PG delivery and compliance with client regulations.
- Quality & Patient Safety: Certified in Patient Safety (CPSO) and Healthcare Quality (CHQ), ensuring high-quality decision-making with a focus on Zero QDI.
- Operational Excellence: Specialized in process improvement, medical auditing, and fraud/abuse prevention.
- Leadership & Capability Building: Division Director (Toastmasters) with extensive experience in coaching, goal setting, and performance review.
- Regulatory Compliance: Deep knowledge of CCHI, CHI protocols, NPHIES, and GAZT (VAT) requirements.
Timeline
RCM & Business Development Manager
Procare-Riaya Hospital
2023.12 - 2025.08
RCM - Business Analyst Manager
GAMA Hospital
2021.10 - 2023.10
RCM - Billing Manager (cash and credit)
Procare-Riaya Hospital
2015.06 - 2021.06
RCM - Revenue Cycle Manager
Mohammad Dossary Hospital
2011.08 - 2014.04
RCM - Billing Manager
Procare-Riaya Hospital
2008.01 - 2011.01
Medical Billing Supervisor
Al-Mouwasat Hospital
2006.07 - 2007.05
Medical Insurance Billing Supervisor
Gulf Specialized Hospital
2004.07 - 2006.06
Finance Department Coordinator
Mohammed Al Dossary Hospital
2003.02 - 2004.06
Patient Account Supervisor
Tadawi General Hospital
1995.05 - 2002.01
Bachelor's Degree - Accounting (Major) / Business Administration (Minor)
Jordanian University
1989.09 - 1993.05
Doctor of Business Administration (DBA) - Business & Admistration
UCAM
MBA - Accounting and Finance
UCAM