MOHAMED SALEM

• Obtained prior authorisation and pre-certification for outpatient procedures.
• Maintained compliance with local and national regulations governing insurance,
• Reviewed accounts receivable reports, insurance contracts and weekly and monthly financial reports.
• Prepared insurance claims for submission to clearing houses or insurance companies.
• Achieved revenue goals by managing collections and accounts receivables, referral process and insurance billing.
• Filed and tracked insurance claims and communicated claims status to patients.
  • Controlling claims unit & training of staff.
  • Technical claims checking and medical auditing
  • Orientation to all new medical staff
  • Weekly departmental workshop
  • E-claims
  • Submission by Wassel, DHS & Other system.
  • Justification & re-submission
  • Monthly analysis

1. Overseeing the insurance operations and designing, implementing and training the
clinic's staff on insurance protocols.
2. Supervising operations within a medical insurance practice. Managing that the insurance
claims are processed in a timely manner and resolving issues that arise during process.
3. Monitoring and analyzing market trends.
4. Studying competitors' products and services.
5. Exploring ways of improving existing products and services, and increasing profitability.
6. Identifying target markets and developing strategies to communicate with them.

Key Responsibilities:
• Overseeing administration of medical services to insurance and corporate patients
or/and customers of the Center.
• Liaising with insurance companies regarding eligibility, payments, reconciliation and
other requirements.
• Organizing training session for concerned employees to develop their understanding of
insurance policies and condition.
• Reviewing insurance claims to ensure accuracy as per agreement, prior to dispatch to
respective insurance companies.
• Proactively reporting critical issues to Management and submits monthly aging and
other reports to line manager and Accounts.
• Designing, updating and implementing policies, procedures and protocols to ensure
efficiency and accuracy in insurance operations.
• Monitoring insurance discounts and rejections and preparing & submitting periodic
reports to the Finance Manager for review.
• Ensuring that the insurance schemes are up to date on the system.

• Conducting weekly departmental meetings with staff for updates and to educate them
on new work methods.
• Attending and organizing the insurance presentation internally and externally.
• Focusing on identifying new business opportunities that fit the strategic direction of the
center and maximizing the outcomes of those opportunities.
• Maintaining extensive knowledge of current market conditions and ensure that any
directly relevant information is communicated to key stakeholders.
• Developing and implementing Public Relations Strategies to position the medical center
as the health care supplier of choice for the KSA and the region.
• Developing and executing business plans.
• Developing relationships with businesses and community groups to promote the clinic's
services.
• Developing and/or marketing new services of the medical center.
• Creating all client proposals, contracts and associated documentation.
• Coordinating with the Corporate Marketing Team to monitor and analyze clinic's media
exposure.
• Providing the necessary guidance and on-job coaching and in-service training for the
staff under my direct supervision.
• Assuming new responsibilities as and when needed.
• Follow all ACCREDITATION BODIES STANDARDS (e.g. CBAHI, JCI & etc.) related to day to
day work and participates actively in quality and performance improvement activities as
guided by the Quality and patient Safety Department.

1. Communication and negotiation with the insurance companies, direct companies as well
as the Ministry of Health (MOH) regarding to the reconciliation of liabilities, Approval,
receiving the rejection statements and follow-up for the claims in a timely manner.
2. Submission of periodic performance reports especially with regard to the e-claims.Management of the following team:
1. Billing Department
2. Approvals Department
3. Contracts Department
4. Medical Review Department

• Communicating with WASEEL & others on line integrated systems in order to improve
the status of approvals & claims submission
• Overseeing the audit process and the counter auditing on all claims before these are
delivered to the insurance companies which includes the following;
1. Medical Review.
2. Management Review (Ordering the invoices, checking the validity of the data
and completing all the necessary required attachments).
3. Counter-checking the deductibles and discount rates as per the agreed
contractual terms.
4. Counter-checking the item prices as per the approved price lists.
• Communication with different Departments (especially Medical Administration, Finance
Department and Medical Records) to highlight day-to-day problems related to the
insurance claims and finding out the suitable solutions to resolve these issues.
• Following-up with the hospital administration to complete the process of medical
reports and put these on the system.
• lmplementation of training courses for the receptionists, doctors and the nursing staff in

order to implement the required data correctly to the system as per the requested e-
claims data.

• Regular follow-up with the Finance Department for the collection of the settled
liabilities on monthly basis.
• Supervision of the claim's cancellation or re-billing process with auditors in order to
facilitate the workflow and to ensure the submission of claims properly.