Naphies
Mona Mohieldin Adam
Inpatient Care Manager
Makkah
Summary
Motivated and adaptable healthcare professional with strong time management, communication, and organizational skills. Committed to continuous learning and excellence in healthcare service delivery. Passionate about patient-centered care, with extensive experience in both primary care and inpatient management across various medical settings. Skilled in insurance patients' medical approval follow-up and quality improvement initiatives.
Overview
11
11
years of professional experience
2011
2011
years of post-secondary education
5
5
Certifications
2
2
Languages
Work History
Inpatient Care Manager
Makkah Medical Center Hospital
06.2023 - Current
- Coordinate access and continuity of care for high-risk patients and those requiring complex treatments.
- Ensure implementation of evidence-based practice guidelines.
- Coordinate approvals for inpatients’ additional services and treatment extensions.
- Daily review of clinical documents to ensure compliance with guidelines.
- Communicate with insurance companies to resolve issues related to approval extensions.
- Notify the Patient Relations Department about rejected cases (e.g., exceeding coverage limits, policy expiration) for transfer to cash categories.
- Coordinate with M.O.H and concerned TPA for MOH-referred cases per agreements and protocols.
- Perform other assigned duties.
- Improve quality aspects related to the role.
- Address safety issues related to the job.
- Maintain confidentiality of accessed information and sign a confidentiality agreement.
- Comply with hospital code of conduct, patient/family rights, and education standards.
- Perform miscellaneous duties as requested.
Outpatient Approval Specialist
Makkah Medical Center Hospital
01.2023 - 05.2023
- Coordinated insurance approvals for outpatient procedures.
- Reviewed and processed patient claims ensuring compliance with insurance policies.
- Communicated with insurance providers, medical staff, and patients to resolve approval issues.
- Maintained detailed records of authorizations and denials.
Home Care Manager
Ministry of Social Affairs
05.2014 - 09.2016
- Conducted assessments of patient needs and collaborated with healthcare professionals to create comprehensive care plans, optimizing patient outcomes.
- Collaborated with physicians on developing patient-centered medical home models that integrated multidisciplinary healthcare teams for improved coordination of services.
Education
Bachelor of Medicine and Surgery (M.B.B.S.) -
Assiut University
Postgraduate Diploma in Dermatology - undefined
Al-Azhar University
Resident - undefined
Dermatology Department, Al-Kharga General Hospital
03.2012 - 07.2014
Skills
- Inpatient care coordination
- Regulatory compliance
- Excel
- Leadership
- Flexibility
- Time management
- Data organization and interpretation
- Problem-solving
- Conflict resolution skills
- Team collaboration
Certification
Saudi Commission for Health Specialties (SCFHS) – General Practitioner Accreditation
Previous Position
Outpatient Approval Specialist, Makkah Medical Center Hospital, Makkah, Makkah, Saudi Arabia, 01/01/23, 05/31/23, Coordinated insurance approvals for outpatient procedures., Reviewed and processed patient claims ensuring compliance with insurance policies., Communicated with insurance providers, medical staff, and patients to resolve approval issues., Maintained detailed records of authorizations and denials.
Personal Information
- Date of Birth: 09/24/85
- Nationality: Egyptian
Current Position
Inpatient Care Manager, Makkah Medical Center Hospital, Makkah, Makkah, Saudi Arabia, 06/01/23, Present, Coordinate access and continuity of care for high-risk patients and those requiring complex treatments., Ensure implementation of evidence-based practice guidelines., Coordinate approvals for inpatients’ additional services and treatment extensions., Daily review of clinical documents to ensure compliance with guidelines., Communicate with insurance companies to resolve issues related to approval extensions., Notify the Patient Relations Department about rejected cases (e.g., exceeding coverage limits, policy expiration) for transfer to cash categories., Coordinate with M.O.H and concerned TPA for MOH-referred cases per agreements and protocols., Perform other assigned duties., Improve quality aspects related to the role., Address safety issues related to the job., Maintain confidentiality of accessed information and sign a confidentiality agreement., Comply with hospital code of conduct, patient/family rights, and education standards., Perform miscellaneous duties as requested.
Software
CareWare
Timeline
Inpatient Care Manager
Makkah Medical Center Hospital
06.2023 - Current
Outpatient Approval Specialist
Makkah Medical Center Hospital
01.2023 - 05.2023
Home Care Manager
Ministry of Social Affairs
05.2014 - 09.2016
Resident - undefined
Dermatology Department, Al-Kharga General Hospital
03.2012 - 07.2014
Postgraduate Diploma in Dermatology - undefined
Al-Azhar University
Bachelor of Medicine and Surgery (M.B.B.S.) -
Assiut University
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