Hossam-adin Mostafa Emam Ashindy

 Responsible for proposing a overall budget, delivering monthly revenue forecasts.
 Supervising and directing employees in their day-to-day tasks.
 Responsible for the direct management of a 10-individual team for improving Revenue Cycle Management Project.
 Assist the CEO on deal due diligence, negotiation, contract development and business development or alliance development projects.
 Make marketing research to update the Price list& packages costing.
 Works closely with the Accounting and Finance groups to discuss the proposed budget; provides inputs to both groups for the purpose of determining the amount of capitalization to be allocated for specific growth-centered projects and proposals.
 Manage client relationships and will work closely with project managers to ensure satisfaction and to develop additional business.
 Performance results and providing coaching and mentoring.
 Recognize, anticipate, and resolves billing, revenue recognition and cash application issues; make recommendations.
 Collaborate with IT to development system enhancements and automation opportunities.

Lead the team of Revenue Cycle Management Improvement project of the Hospital, Manages key client project,
Coordination and completion of projects on time within budget and within scope, Oversee all aspects of projects. Set deadlines, assign
responsibilities and monitor and summarize progress of project. Prepare reports for upper management regarding status of project

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).

I have more than (18) years of experience of Healthcare services& Hospitals Business Process Mgmt.
I'm Interested in implementation of Business& Technology methodologies in Healthcare Services& Health Providers area. focused on:-
📊Business Process Management(BPM)/Re-engineering(BPR) for Health Services&Hospitals Mgmt.
☔Medical Insurance Business Process Management (BPM).
💡Business Innovation for Healthcare Services&Health Providers Mgmt.
💻Digital Healthcare Services Transformation (e-Health) .

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:-
• Leading the resubmission team and help OPD, Inpatient& Claims Insurance Teams.
• Managing operations and productivity at an insurance department.
• Finalizing and reconciling accounts with Insurance Companies & TPAs.
• Creating and modifying procedures and documents related to policies and analyzing risks related with policies.
• Business development: setting strategies to expand the hospital’s market share.
• Monthly reporting to hospital's administration of: outstanding insurance companies’ balances, average cost per claim, rejection rates, commercial reconciliations, revenue collection, and income breakdown.
• Reviewing insurance policies activation (Applying policy's instructions) on (HIS).
• Share in preparing e-claim & updating hospital information system to plug in SHIB Project.
• Resubmission unit and ensuring that all rejected claims were resubmitted within the required timeframe..........
• Applied ICD-10/ACHI as good tools to control Insurance Process& have an idea of Innovative Creative Project about this issue.
• Conduct auditing function of All Inpatient Approvals.
• Review All Inpatient Approval Pre- Admission.
• Performing quality control& monitoring for In-patient & Outpatient Approvals.
• Conduct training sessions about health insurance for doctors and nurses.
• Conduct training sessions about health insurance for Insurance team.
• Conduct training sessions about health insurance for External Insurance.
• Communicate Health Insurance concepts to Public specially Insured.
• Handling pricing function for surgical procedures.
• Setting policies, procedures to optimize the cost effectiveness of the Department.
• Contact with Insurance companies/TPAs to facilitate patient Approvals.
• Contact with Insurance companies/TPAs /Hospitals to facilitate transfer of patient to another providers.
• Conduct of customer service function to solve insured‘s complex problems.
• Conduct of marketing function via communication with Insurance companies/TPAs /Hospitals and policyholder.
• Share in developing Insurance department policies and procedures.
• Support senior managers and executives with daily insurance data.
• Share in Development, implement and improvement hospital policies and procedure.
• Share in Development goals and objectives that tend to growth of Business.
• Share in Design and implement business Development plans and strategies to promote the attainment of goals.
• Share in Design and implement marketing plans and strategies to promote the attainment of goals.
• Share in Organization and coordination Insurance department operations in ways that ensure maximum productivity.
• Supervise Insurance team and provide feedback and counsel to improve efficiency and effectiveness.
• Maintain Good relationships with Insurance companies/TPAs/other hospitals.
• Gather, analyze and interpret external and internal data about insurance market and write reports.
• Assess overall company performance against objectives.
• Represent the department in events, conferences etc.

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.

Job description: \{as a Salesman & Customer Services\}