DR. AHMED EL MAZALY

Work History

Revenue Cycle Management (RCM) Director

Premier Medical Imaging Centers (PMIC)

- Current

In this role, I oversee all aspects of the revenue cycle, including billing, coding, claims management, and reimbursement processes. My leadership ensures the optimization of financial performance and compliance with the regulations.

Head of medical department

Aljazira Takaful Insurance

12.2021 - 07.2025

Managing the medical claims team to oversee the performance, productivity and quality of the TPA teams. Managing the medical claims team to ensure claims are processed efficiently and correctly. Managing the medical claims team to ensure complete and sound claim settlements, legal reviews and investigations in accordance with company policies and procedures. Managing the medical claims team to investigating potentially fraudulent claims. Maintain company's records on claims and providing reports to senior management on a regular basis. Providing professional advice to staff and senior management on all aspects of medical insurance practice and regulations. Managing the Medical underwriting team to create pricing quotations to the new and renewed medical insurance businesses. Managing the Medical underwriting team to ensure the completion of all the necessary documents to issue medical insurance policies. Managing the medical underwriting team to ensure the compliance with of the issued medical policies with the regulations of regulators (Insurance Authority). Managing the medical underwriting team to monitor the policies' performance and prepare regular reports to the top management about the policies' performance. Managing the medical underwriting team to prepare the loss ratio reports to the policyholders.

Medical Claims Manager

Aljazira Takaful Insurance

07.2021 - 12.2021

Managing the medical claims team to oversee the performance, productivity and quality of the TPA teams. Managing the medical claims team to ensure claims are processed efficiently and correctly. Managing the medical claims team to ensure complete and sound claim settlements, legal reviews and investigations in accordance with company policies and procedures. Managing the medical claims team to investigating potentially fraudulent claims. Maintain company's records on claims and providing reports to senior management on a regular basis. Providing professional advice to staff and senior management on all aspects of medical insurance practice and regulations.

Claims Manager

Fakeeh Care

02.2020 - 06.2021

Medical and technical auditing of claims. Monitoring billing activities, billing rules, performance management, and production standards and quality of results. Providing technical assistance to staff to initiate billing to all appropriate payer types. Analyzes data for bill presentation based on requirements and reviews claims for quality. Works to prepare and supervise the preparation of processes and bill presentation to ensure quality and accuracy.

Medical Preauthorization Manager

Saudi Enaya for Cooperative Health Insurance

01.2010 - 11.2019

Managing the Preauthorization team to Achieve the daily KPI in quality and quantity to achieve highest customer service experience. Managing the Preauthorization team to Adjudicate received medical requests according to policy, limit and evidence based medical standards to prevent abuse, fraud and overutilization. Maintain full coordination with colleagues in Sales, Customer service departments by providing them with all the support needed to solve complaints arising because of preauthorization process. Development of clinical guidelines and clinical pathways as per the international clinical standards, evidence-based medicine and Saudi clinical market practice.

Preauthorization Supervisor

Saudi Enaya for Cooperative Health Insurance

06.2015 - 12.2015

Offer professional help to new staff provide positive feedback and help in solving problems arising from everyday practice. Take active part in all administrative work related to team performance such as reports, data analysis, Timetables, Automation, system upgrading, etc. Achieving the daily target set by management in its dimensions, quality and quantity to achieve highest customer service experience.

Senior Medical Officer

Saudi Enaya for Cooperative Health Insurance

04.2013 - 05.2015

Reviewing and adjudicating the preauthorization requests from different healthcare providers according to evidence-based medicine and Saudi Enaya policy. Answering different medical and policy queries from different departments (sales, relationship managers and customer service).

Clinical Governance Specialist

Bupa Arabia

05.2012 - 03.2013

Develop, implement, and maintain Evidence based medical standards and clinical guidelines to support Building Capabilities, Medical Cost Management, Branding, and Service Differentiation. Measure, monitor, and audit Clinical Quality provided to Bupa members in hospital covered by HAD to ensure patient safety, Medical Cost Management, Branding, And Service Differentiation. Reviewing and improving Medical Decision Matrix to enhance Customer Experience, And Service Differentiation. Standardizing CERS among medical teams dealing with customers to ensure Patient Safety in Critical Situations, and Support Service Differentiation. Building, maintaining and updating a Medical Capability Building Manual in alignment with Business Capability Building Strategy. Standardizing Medical Operational Procedures and Developing Task Specification Medical Training Manual in alignment with Business Capability Building Strategy. Developing and delivering Training for Best Medical Practices for Clinical Staff to ensure Medical Cost Management, and Service Differentiation. Initiation, driving and implementation of Health Care Leadership Agenda and Initiatives. Governing all health related promotional and educational materials provided by Bupa to its members, in alignment with the Group Health Standard, Market Values, and Health Credentials.

Clinical Governance and Healthcare partnership Doctor

Bupa Arabia

01.2011 - 04.2012

Working on the "Healthcare Partnership" Agenda: "Doctor on phone" providing medical consultations to Bupa members and non-Bupa members. Working on "Cancer Safe Program". Working on "Maternity program". Working on the capability building of all the medical staff: Developing Clinical practice guidelines. Developing Clinical Assessment to different medical staff. Sharing in the development of the medical contents on Bupa website. Sharing in revising the medical contents included in all internal and external communications.

Medical Advisor

Bupa Arabia

01.2010 - 12.2010

Working on the VOC "Voice Of Customer", reviewing the medical decisions made by the preauthorization team and created a complaint. Working on "Doctor on Phone", providing medical consultations to Bupa members and non-Bupa members. Building the basis for the "Medication Control" project.

Senior Medical Officer

Bupa Arabia

07.2007 - 12.2009

Reviewing and adjudicating the preauthorization requests from different healthcare providers according to evidence-based medicine and Bupa policy. Answering different medical and policy queries from different departments (sales, relationship managers and customer service). Acting as team leader in the preauthorization team in absence of the medical manager. Product pricing (Before creating the underwriter position)

Resident In the Egyptian Fellowship of Internal Medicine

Banha Educational Hospital

12.2003 - 07.2007

Resident of Rheumatology, Rehabilitation & Physical Medicine

Banha Educational Hospital

01.2000 - 12.2003

Resident of Rheumatology, Rehabilitation & Physical Medicine

Quesna Central Hospital

07.1999 - 01.2000

General practitioner [G.P]

El Menya Governorate (MOH)

09.1997 - 07.1999

House Officer

Banha University Hospital [G.P]

09.1996 - 08.1997

Summary

Overview

Work History

Revenue Cycle Management (RCM) Director

Head of medical department

Medical Claims Manager

Claims Manager

Medical Preauthorization Manager

Preauthorization Supervisor

Senior Medical Officer

Clinical Governance Specialist

Clinical Governance and Healthcare partnership Doctor

Medical Advisor

Senior Medical Officer

Resident In the Egyptian Fellowship of Internal Medicine

Resident of Rheumatology, Rehabilitation & Physical Medicine

Resident of Rheumatology, Rehabilitation & Physical Medicine

General practitioner [G.P]

House Officer

Education

MBBS - Medicine, Medicine and Surgery

Skills

References

LANGUAGES

Timeline

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