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السلام عليكم
# I'm open for new challenge opportunity to add a value to your well known organization .
I'm Interesting in creativity& innovation of Healthcare Services& Hospitals Management
Showing that through three (3) tracks:-
Medical/Health Insurance Processing Management.
Business Administration& Business Innovation.
Digital Healthcare Services (e-Health) Transformation.
I possess multidisciplinary knowledge& experience which based on my qualifications& skills on
((( Business Administration+Management+ Information System + Health Sciences + Technology ))):-
1- Health Insurance Management.{ Health Insurance professional + about (8) years of experience }
2- Revenue Cycle Management.
3- Technology Innovation Management(TIM) for Health services& Hospitals. {membership-S.S.H.A}
4- Biomedical& Health informatics.
5- Clinical /Medical Coding. { workshop training }
6- Medical Terminology& CDI. {3 years course of basic sciences of medicine}
Thereby; I'm Health Insurance Processing Advisor;
## Provide professional consultations in relation to Health Insurance/Regulations.
##Provide assistant to researchers who are looking for answers to the Health Insurance sector within KSA.
Target Job :
1- Management of Medical insurance industry highly professional; Approvals, claim processing ,relationships, Customers service, marketing, Rejection-Reconciliation process& Supervise Business Center.
2- Management of Healthcare& Hospital industry professionally.
3- Furthermore, I'm looking forward to starting a new career in Digital Health (e Health), TIM in Healthcare or Clinical Coding; (audit Clinical Documentation Improvement (CDI).
4- Generally; Business Administration, Management, Marketing& Customers Service .
Regards
Mr. Hossam-adin
+966 565 88 4114
[email protected]
Egyptian With Saudi Resident ID of Saudi Citizen Husband /Special Expatriates= وافـد خـاص
Provide consulting services for providers (hospitals/clinics) to:-
1- Assist and supervise the establishment of the department of medical insurance processes /Business Centre
2- Evaluate the performance& productivity of the various units of the department:
2.1-Approvals Unit (outpatient& inpatient submission), 2.2- Medical Claims Process Unit,
2.3- Rejection& Reconciliation Unit, 2. 4- Marketing, Relations& Customers service Unit.
3- Get the licence of ICD-10 from Saudi Health Council& licence of C.C.H.I to process the Health Insurance.
4- (Apply ICD-10 AM/ACHI, 6'Th edition + e-claim form) as good tools to control Insurance Processes ,Transformation to Digital Health Form, to be ready to merge with& plug in SHIP project.
5- Control & handle Revenue Cycle management (RCM).
Main role:-
prepare& Audit the claim technically& medically, preside the submission of approval requested, examine medical records, billing information, medical processes and regulation to identify inaccuracies, compliance issues, handle all related issues from insurance companies to insure the accuracy of claims, monitor approvals of admission to avoid missed days& update for new medical procedures............
Primary responsibilities include{ indetails }:-
(Look the attached CV.)
Primary responsibilities include:-
•Assist patients and provide helps and understanding policy benefits.
• Coordinate with the insurance companies to get the approvals of both OPD & In-patients.
• Manage, prepare and handle rejections for distribution in the clinics.
• Activate & identify the policies in the hospital information system (HIS).
• Advise IT-technicians to handle the hospital-system to match with different policies.
• Monitor approvals of admission to avoid missed days & update for new medical procedures.
• Authorized covered & not covered services {drugs& medical procedures & accessories}.
• Prepare & Audit the claims technically & medically.
• Contact & coordinate with the insurance’s doctors & insurance’s customer-services.
• Update the orientation by the cooperative health insurance policy {terms, conditions, benefits & exclusions} that be authorized by the council of cooperative health insurance.
• Train & help new employees on the use of the hospital information system.
• Create & originate a good simple project ((E-claim)) which controls insurance department & helps reduce the rejections ((technical & medical)) to the minimum ratio.
Primary responsibilities include:-
• Submit approval requests of outpatient department(O.P.D).
• Contact with insurance companies to get the final approval status.
• Assist patients and provide help and understanding policy benefits.
Job description: marketing of medication
N.B: had a private business of outdoor pharmacy during this period.
description: {as a Salesman & Customer Services}