Dr. Mohamed Amer
ABHA,Saudi Arabia
Summary
Accomplished professional with extensive expertise in operations management and revenue cycle management. Demonstrates proficiency in Microsoft Excel, data analytics, and quality assurance. Adept at crisis management, visionary thinking, and budget control. Proven track record in driving growth initiatives, business development, and contract negotiation. Strong leadership acumen and decision-making competency. Skilled in utilizing CRM systems to enhance operational efficiency. Committed to leveraging skills for continued career advancement and organizational success.
Overview
11
11
years of professional experience
2012
2012
years of post-secondary education
1
1
Certification
Work History
Operation and Revenue Cycle Director
Comprehensive Family Medical Group
ABHA, Saudi Arabia
01.2022 - 04.2025
- Management of HealthCare Group Operation and Revenue Cycle:
- Worked with board of directors to establish objectives and decisively lead operations.
- Oversaw daily operations to achieve high productivity levels.
- Implementation of the Strategic plan for the Organization and reviewing the Achievement on Weekly and Monthly Basis.
- Oversaw daily operations to achieve high productivity levels.
- Established budgets based on historical, current and forecasted business data.
- Follow up of the Providers Revenue Cycle for Cash and Credit, Discussing and solving obstacles facing concerned teams.
- Review Year to Year, Month to Month Revenue Analysis verifying the upgrade if target achieved and discussing available solutions if target not Achieved.
- Discuss and perform Root Cause Analysis to solve the issues interfering with the operation with the concerned Department.
- Review Clinics Revenue with the Medical Director on Weekly basis with closed Discussion about Medical Staff Performance.
- Review Marketing Campaigns with strict monitoring of Reachability to target Audience and Achievement.
- Review Sales team Achievement and analysis of adherence to the targets.
- Review the Revenue Cycle and the whole process of Medical Insurance with Insurance Department to Assure Achievement of better patient experience by Approval Requests Submission as per accepted SLA with Approval re-submission for the rejected Requests, Billing Submission in due Dates with the highest Quality to decrease initial Rejection, Monitoring the performance of Reconciliation team and reviewing Closing % with the payers and Reviewing contract Status for each payer.
- Established NPHIES Mapping and NPHIES Activation as per CHI Regulation.
- Championed change initiatives within the organization for streamlined operations.
Operation and Revenue Cycle Manager
Saudi German Health
Jeddah, Saudi Arabia
11.2020 - 01.2022
- Management of Operation and Revenue Cycle:
- Supervised project timelines for timely completion.
- Optimized resource allocation for increased profits.
- Secured new business opportunities with successful networking events.
- Planned revenue generation strategies designed for growth.
- Management of Approval Operation, follow up Approval Requests sent to insurance companies and assure Achievement of maximum Quality, sending and receiving Approvals from the payer in the Accepted TAT.
- Management of Billing, assuring Claims Submission in Due Dates with Accepted SLA.
- Management of Rejected Claims by monitoring the performance of Resubmission unit to ensure reply to all rejections sent from the payer side.
- KPI monitoring for Staff performance.
- Established NPHIES Mapping and NPHIES Activation as per CHI Regulation.
- Monitoring Referral Cases from insurance Companies, reporting the Deficit in some insurance Companies referrals and notify the corporate sales teams to act as per the mentioned Analysis
- Deal with Insurance Companies regarding Contracts Renewal and Ensure sending well Studied Proposals during the contract notice period with Accepted levels of Discount Percentage
- Review and Manage Discounts and Strict Data Analysis to guarantee Renewal Benefits
Deputy Insurance Manager
Andalusia Group for Medical Services
Jeddah, Saudi Arabia
08.2020 - 11.2020
- Management of Approval Operation, follow up Approval Requests sent to the payer and assure Achievement of maximum Quality, sending and receiving Approvals from the payer in the Accepted TAT.
- Management of Claims Billing, assuring Submission in Due Dates with Accepted SLA.
- Management of Rejected Claims by monitoring the performance of Resubmission unit and ensure reply to all rejections sent from the payer.
- Monitoring of Reconciliation Process to close on less than 5% agreed rejection.
- KPI monitoring for Staff performance.
- Established NPHIES Mapping and NPHIES Activation as per CHI Regulation.
- Monitoring Referral Cases from insurance Companies, reporting the Deficit in some insurance Companies referrals and notify the corporate sales teams to act as per the mentioned Analysis.
- Deal with Insurance Companies regarding Contracts Renewal and Ensure sending well Studied Proposals during the contract notice period with Accepted levels of Discount Percentage.
- Review and Manage Discounts and Strict Data Analysis to guarantee Renewal Benefits.
Medical Claims Section Head
Andalusia Group for Medical Services
Jeddah, Saudi Arabia
10.2019 - 08.2020
- Follow up the process related to Medical Claims Submission to ensure early flow of insurance companies (Payer) payment
- Review Jumbo Medical Claims with Claims supervisors before sending to the payer to assure Strict Claims auditing.
- Review reports from Medical Claims Supervisors regarding Patient Count and Network Classes from each payer to guarantee Constant and Increased patient Count.
- Monitor referral cases directed to the provider from the payers and assure it is as per contract agreement.
- Monitor Provider network in comparison with Competitors to make sure that we provide relevant Pricelist to networking.
- Monthly review reports about KPI of Claims Staff.
Medical Claims Supervisor
Andalusia Group for Medical Services
Jeddah, Saudi Arabia
12.2017 - 10.2019
- Follow up the process related to Medical Claims Submission to ensure early Cash flow from the Payers.
- Complete the Medical Audit for Claims with the Administrative part from the Billing Officers
- Review Jumbo Claims with from Medical Claims Section Head.
- Monthly review reports about KPI of Claims Staff.
Senior Pre-Certification&Quality Assurance Officer
Globemed Egypt
Cairo, Egypt
11.2016 - 04.2018
- Submit Approvals for inpatient and outpatient requests received from the healthcare providers as per the contract regulation between the payer and Provider.
- Auditing Approvals of other Staff Colleagues for Quality issues.
- Training Administration for Newly Joined Staff on Approval Submission on i care System.
Senior Pre-Certification Officer
Med Right For Medical Services
Cairo, Egypt
01.2014 - 06.2016
- Submit Approvals for inpatient and outpatient requests received from the healthcare providers as per the contract regulation between the payer and Provider
- training for Newly joined Pre-certification Staff
Physician
National Service Projects Organization/Armed Forces
Cairo
10.2014 - 12.2015
Education
BSc - Medicine and Surgery
Ain Shams University
Secondary school - undefined
Tabary Roxy Secondary school
Skills
- Operations Management
- Revenue Cycle Management
- Microsoft Excel
- Computer Skills
- Quality Assurance
- Data analytics
- Crisis management expertise
- Visionary thinking
- Budget control aptitude
- Growth initiatives
- Leadership acumen
- Contract negotiation techniques
- Decision-Making competency
- Knowledge of crm systems
- Business development
Certification
- Management Fundamentals
- The Economics of Health Care Delivery
- Operations Management Foundations
- NPHIES COD-02 FOR HCP
- NPHIES CP01 FOR HCP
- NPHIES INT-01 FOR HCP
- NPHIES-MAP01
- PTH-HOSPITAL REVENUE CYCLE MANAGEMENT
- PTH-MEDICAL MALPRACTICE INSURANCE
- PTH-VALUE BASED HEALTHCARE
Custom
- 04/2020, Value Based HealthCare
- 03/2020, Medical Malpractice
- 03/2020, Hospital Revenue Cycle Management
- 01/2020, Management Fundamentals
- 12/2019, The Economics of Health Care Delivery
- 07/2012, First Aid Course at Ain Shams University
Personal Information
- Date of birth: 11/28/87
- Nationality: Egypt
- Marital status: Married
Timeline
Operation and Revenue Cycle Director
Comprehensive Family Medical Group
01.2022 - 04.2025
Operation and Revenue Cycle Manager
Saudi German Health
11.2020 - 01.2022
Deputy Insurance Manager
Andalusia Group for Medical Services
08.2020 - 11.2020
Medical Claims Section Head
Andalusia Group for Medical Services
10.2019 - 08.2020
Medical Claims Supervisor
Andalusia Group for Medical Services
12.2017 - 10.2019
Senior Pre-Certification&Quality Assurance Officer
Globemed Egypt
11.2016 - 04.2018
Physician
National Service Projects Organization/Armed Forces
10.2014 - 12.2015
Senior Pre-Certification Officer
Med Right For Medical Services
01.2014 - 06.2016
Secondary school - undefined
Tabary Roxy Secondary school
BSc - Medicine and Surgery
Ain Shams University
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