Mohammed Mitwally

RCM director role is responsible for overseeing the full revenue cycle function—from patient registration to final payment—ensuring optimal financial performance, regulatory compliance, and alignment with clinical operations. The RCM Director will manage key sub-units, including the approval section, contract management, coding unit, claims processing, data analysis, and regulatory compliance. This role reports directly to the CMO and will act as a key advisor on all matters related to the financial and operational health of revenue systems.

Key Responsibilities:

• Provide strategic direction and oversight for all RCM functions in alignment with hospital goals and regulatory requirements.
• Work closely with the CMO and clinical leadership to ensure a seamless integration of clinical and financial processes.
• Operations Management
• Oversee the end-to-end revenue cycle including insurance approvals, coding, claims submission, denials management, collections, and reconciliation.
• Ensure timely and accurate processing of patient billing and third-party claims.
• Contract Management
• Lead negotiations and management of contracts with insurance payers and third-party administrators.
• Ensure contract terms are reflected accurately in billing practices and reimbursement models.
• Medical Coding and Documentation
• Supervise the medical coding team to ensure accuracy, completeness, and compliance with ICD-10, CPT, and regulatory standards.
• Support continuous training for coders to maintain updated certifications and knowledge.
• Claims & Approvals Oversight
• Manage pre-authorization and insurance approval workflows to minimize delays in patient care.
• Monitor claim submission, rejection trends, and drive initiatives to improve first-pass rates.
• Data Analytics & Reporting
• Lead the development of RCM performance dashboards and KPIs, offering insights to drive operational decisions.
• Collaborate with IT and clinical departments to leverage data for improving revenue cycle efficiency.
• Regulatory Compliance
• Ensure RCM practices are compliant with all applicable healthcare laws, payer policies, and accreditation standards (e.g., CBAHI, NHIC, MOH).
• Serve as the hospital’s point of contact during external audits and payer reviews.

• OVERSEE THE ENTIRE INSURANCE REVENUE CYCLE PROCESS, INCLUDING BILLING, CODING, CLAIMS PROCESSING, AND COLLECTIONS.
• DEVELOP AND IMPLEMENT STRATEGIES TO MAXIMIZE INSURANCE REIMBURSEMENTS AND MINIMIZE DENIALS.
• MONITOR KEY PERFORMANCE INDICATORS RELATED TO INSURANCE REVENUE CYCLE, SUCH AS DAYS IN ACCOUNTS RECEIVABLE, DENIAL RATES, AND CLEAN CLAIM RATES.
• COLLABORATE WITH OTHER DEPARTMENTS, SUCH AS FINANCE AND MEDICAL RECORDS, TO ENSURE ACCURATE AND TIMELY BILLING AND CODING PRACTICES.
• STAY UP-TO-DATE ON CHANGES IN INSURANCE REGULATIONS AND POLICIES THAT MAY IMPACT REIMBURSEMENT RATES OR CLAIM PROCESSING.
• TRAIN AND SUPERVISE STAFF MEMBERS INVOLVED IN THE INSURANCE REVENUE CYCLE PROCESS, PROVIDING GUIDANCE AND SUPPORT AS NEEDED.
• ANALYZE DATA RELATED TO INSURANCE REVENUE CYCLE PERFORMANCE AND IDENTIFY AREAS FOR IMPROVEMENT OR OPTIMIZATION.
• COMMUNICATE REGULARLY WITH INSURANCE COMPANIES TO RESOLVE BILLING ISSUES OR DISPUTES IN A TIMELY MANNER.
• DEVELOP RELATIONSHIPS WITH KEY STAKEHOLDERS, SUCH AS PAYERS AND THIRD-PARTY VENDORS, TO ENSURE SMOOTH OPERATIONS OF THE INSURANCE REVENUE CYCLE.
• PARTICIPATE IN AUDITS OR REVIEWS OF THE HOSPITAL'S INSURANCE REVENUE CYCLE PROCESSES TO ENSURE COMPLIANCE WITH REGULATORY REQUIREMENTS AND BEST PRACTICES.

• Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
• Prepared internal and regulatory financial reports, balance sheets and income statements.
• Identified improvement changes regarding key processes for internal controls and accounting procedures.
• Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
• Strengthened communication skills through regular interactions with others.
• Exercised leadership capabilities by successfully motivating and inspiring others.
• Identified issues, analyzed information and provided solutions to problems.
• Delivered services to customer locations within specific timeframes.

• Responsible for supervising operations within an insurance practice.
• Manage adjusters, investigators, and appraisers.
• Insures claims are processed in a timely manner and resolves issues that arise during process.
• Liaison for client and insurance company inclining claims.
• Worked with department staff to research, identify and provide solutions to client and insurance company inquiries.
• Facilitated meetings with CFO of insurance billing company to resolve issues, outstanding receivable and collections.

• Conducted research, gathered information from multiple sources and presented results.
• Handled several calls per day to address patient inquiries and concerns.
• Worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
• Managed team of employees, overseeing hiring, training and professional growth of employees.

• Monitored vital signs during treatments and adapted plans to maintain patient comfort.
• Kept detailed records of medical conditions and histories to provide best-in-class and individualized care.
• Evaluated patient histories, complaints and current symptoms.
• Teamed with other physicians, specialists and health care providers to provide well-rounded care for complex cases.

• Worked flexible hours across night, weekend and holiday shifts.
• Exceeded goals through effective task prioritization and great work ethic.
• Resolved problems, improved operations and provided exceptional service.
• Used critical thinking to break down problems, evaluate solutions and make decisions.

• Resolved conflicts and negotiated mutually beneficial agreements between parties.
• Conducted research, gathered information from multiple sources and presented results.
• Worked within applicable standards, policies and regulatory guidelines to promote safe working environment.
• Maintained energy and enthusiasm in fast-paced environment.