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CV Healthcare director, Medic, MBA, FAIHQ, CSSBB, MBBS

 
Healthcare director, Medic, MBA, FAIHQ, CSSBB, MBBS

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CV/Resume ID no.: 88860

Location (Residence): riyadh, Saudi Arabia
Citizenship: Egypt
 
Languages:
  Native: Arabic Egypt
  Other: English United States
 
Education & Experience: Work Authorization & Relocation:
Education:
  Masters in MBA

Years of Experience: 18 years
Authorized to work in:
   Egypt, Saudi Arabia
Present Location:
   SAUDI ARABIA, riyadh
Relocation:
   Anywhere (International)
 
Expertise
Category Subcategory Ability Experience
Health & Safety Emergency Response Experienced 13 years
Management Health & Safety Experienced 12 years
Other Medic/Doctor Experienced 25 years
 
CV/Resume Details
 
1. Summary (Cover Letter) - CV/Resume Part 1 [Mandatory]

Dear Sir:

In response to your company's advertisement regarding a Medical position, I am enclosing a resume for your review. Upon my graduation, I would enjoy joining work with your team. My experience is 17 years serving in different medical fields and health management e.g. (I.C.U, emergency director, G.P, CO. Doctor, healthcare quality specialist, medical insurance, and medical director). My experience vary from in-house clinic in reputable organizations, polyclinics, big hospitals to insurance co.; 8 years in Egypt and 9 years in K.S.A

I have extensive knowledge of medical policies and protocols. I have experience in caring for multinational patients and their families. I have worked collaboratively with primary caregivers, health care professionals, and other counselors to create service plans, increase family communication, and promote safety for workers.

My current qualification are; MBA, FAIHQ, CSSBB, and MBBS. My current position is {the medical director} of Saudi lighting co. which is the leader co. in lighting fixture in the Middle East. Caring for about 1000 employees and their families have provided me a clinical and administrative setting to perform individually, familiar, or team counseling.

I am confident that my knowledge of proactive medical care systems, safety, my understanding of local laws and regulations and my wide-ranging good relationships with most of medical providers would make me an excellent addition to your team.

I hope to get a chance in your reputable and leading corporate to help in achieving its mission

2. Work Experience - CV/Resume Part 2 [Mandatory]

October, 2003 − Current Health Care Administrative Manager
Organization: Saudi Lighting co. (SLC) K.S.A
Objectives: 1) healthcare quality management:
- Continuous quality improvement
- Total quality management
- Implementation of JCI standards
- Implementation of (EBM) (evidence based medicine) in practice and pre authorization
- Developing official forms, regulations , and manuals
- Information management (design, analysis, interpretations, act, and solutions)
- Risk management and patient safety
- Continuous readiness
- Performance Management and Improvement ( Planning, Implementation, Evaluation, and Integrations)
- Survey and Analysis of customer (internal and external) satisfaction

2) Administration of Self Insurance Program:
- Underwriting the policy
- Budgeting the expenses
- Negotiation with provider & sign contract with to serve our staff in 14 branches all over the kingdom
- Auditing monthly claims based on standard & EBM (Evidence Based Medicine)
- Approval of medical services before process to be sure from its necessity and effectiveness.
- 24 hrs. managed care program
- Reimbursement of cash claims based on the internal policy
- Using (file maker) which is a simplified data base software program simple design to meet requirement, it helps in doing many analytical data as a tool for sound decisions like (revisit rate, average claim)
- Monitoring & controlling expenses and sick leaves every month using special charts to control the budget without any deviation from the health care quality
- Preparing annual and semiannual reports and represent it in board meeting
- Innovating new packages like (per visit deal) which is now commonly used by many co. and providers after proving its effectiveness and cost control
3) Running in-house clinic
4) Reducing occupational accident by auditing with HSE department to get zero accident


January, 2001- Jan 2005 Health Insurance Coordinator (part time) K.S.A
Organization: SACIR (Saudi American co. for Insurance and Reinsurance)
- Three months awareness period for internal regulation & procedures of SACIR co. & CENTRA TPA co. in all departments e.g. claim process department, auditing department, cash claims, operation department, approval department, hotline services, R&D, accounting, etc.
- In lieu of any vacant position due to absence or resignation till hiring a new candidate
- Held discussion with consultants (Case Study Committee) weekly to study complicated cases & to reach the best solutions
- Continuous searching the state-of-the-art investigations, treatments, budgeting, services and implementing it to reach the best quality level & improvement.
- Interrelation movements between internal and external customers
September, 2000 - September 2003 Co. Doctor, Health & life Insurance Coordinator K.S.A
Organization: International Building System Factory (IBSF) one of the leader companies of ASTRA group
Objectives: 1) Health and Life Insurance Coordinator
- Developing policy clauses of health and life bidding for IBSF and represent it to chairman for his approval.
- Study, analysis and evaluation of proposals, represent a summary to chairman for discussion
- Implementing the policy & regulations stated in the main policy
- Personnel staff awareness how to use addition, deletion and upgrading forms
- Preparing small guide including summary of policy clauses and distribute it for all employees.
- Problem solving, clearing confusion between insurance co. , beneficiaries & third party
- Advanced research to justify the approval & rejection and negotiate according to policy clauses and recent researches
- Revision of annual statement of account received by the insurance co. to calculate the profit share % and consider it as down payment in renewal the policy
- Preparing cash claim and follow reimbursement process and negotiate the rejected item
- Interrelation movements with insurance co. staff to promote policy quality and control expenses
2) Running the in-house clinic
3) Occupational Health and Safety Auditing
4) Referring the occupational accident to GOSI (general organization of social insurance) hospital and following up the compensation claims based on Aqtuarians Schedules and doing objection letter if there is any unsatisfied process

June, 1999 - September 2000
Health Insurance Coordinator & Director Of Emergency Department
Organization: Al−Nakheel Policlinic K.S.A
Objectives: 1) Insurance
- Three months with IT programmer to develop the system which meets the requirements of insurance contracts. e.g. policy instructions, policy holder, ID card coverage & exclusion, discount % & volume discount, coinsurance, deductions & financial system etc.
- Training the physicians on how to use the program
- Training the physicians on how to deal with the insurance principle e.g. how to fill the claim form with data which is important for insurance co., how to fill the pre-approval form, covered item, exclusions, etc
- Training the accountant on how to use the program, how to prepare the invoices, how to prepare statements & follow up.
- Contacting with insurance co. & signing up contracts
- Monitoring the satisfaction of insurance co. and insured persons
- Reviewing the claims before submitting them to insurance co. and fill the missed item with the treating doctor to avoid any rejection
- Planning for the procedure starting from contract sign, visit of the insured person, preparing file, doctor visit, writing prescription, and receiving medication, invoices revision, and submit to finance department.
- Monthly group meeting with the staff to solve any problem & inform them according to new contracts & any new procedure or any suggestion to improve the quality of service
- Training the team on quality performance by surveying points of weakness to strengthen and improve them in a team spirit
- Auditing the rejected claims and submitting the reply, discussing and negotiating with insurance co. auditor.
2) Emergency department:
- Director of emergency department, monitoring their performances, improving the quality of service, *Preparing emergency department manual and doing survey for patient satisfaction to meet polyclinic goals & mission


November, 1996 - May 1999 General Practitioner
Organization General Institute Of Health Insurance (Egypt)
Experiences G. P. at different clinics
- One year at school health insurance for about 4 schools ( 2 hours daily in each) implementing all governmental health insurance roles.
- 6 months at Diabetes Center of general institute for health insurance
- 3 months at in-house clinic of Alexandria electrical co.
- 1 year in Al Mansheya clinic which is specified insurance polyclinic for geriatric, this clinic serving more than 50, 000 retired employees and follow the regulation of governmental health insurance
March, 1992 - March 1996 - Resident G.P
Organization - AL−Amyria Governmental hospital Egypt, a specialized hospital in emergency
Experience - Resident physician in ICU (intensive care unit) more than 20 admitted cases in ICU every day)
March, 1996 - November 1996 - G.P and resident doctor in ICU.
Organization - AL−Zoghby Private Hospital. Egypt


3. Education & Training - CV/Resume Part 3 [Mandatory]

Certified Six Sigma Black Belt (CSSBB) Anexas Consultancy,India, in July, 2008
Fellowship of American institute of healthcare quality (FAIHQ) American Institute of Healthcare Quality, in July 2007
Master of Business Administration (MBA)
Majoring in (Business Administration) West coast university, Los Angeles, California USA, in March, 2005 www.westcoastuniversity.us

Bachelor of Medicine (M.B.B.cH)
Faculty of Medicine, Alexandria, Egypt, in November, 1991
Preparing for Health Insurance Associate (HIA) American Insurance Health Plan (AHIP)

Training courses:
- (Quality &Safety As An Organization Imperative) Johns Hopkins International held at Riyadh may 27,2008
- (Strategic planning) Al- Khorayef Management System, held at Riyadh In-house Training, November 11-12, 2007.
- (Advanced Health Quality Management for Health Professional), held at King Abdul−Aziz University, Jeddah, May13−17, 2006.
- (International patient safety summit), held at the Security Forces Hospital Program, September16-18, 2006.
- (Laboratory quality day), held at the Saudi German Hospital, January 24th, 2004.
- (OHSAS ISO 18001 Occupational Health and Safety Assessment Series) Nigel Bauer & Associate UK, held in Riyadh, May 3−5, 2004
- ISO 14001: 2004 awareness (Environmental Management System), conducted by (FAHSS); a member of RWTUV (Rheinisch-Westfälischer Technischer Überwachungsverein), Germany, April 27th, 2005.
- ISO 17799 / BS 7799 (Information Security Management System), conducted by (FAHSS), May 24th, 2005.
- Effective Communication Skills seminar which is very important and vital for TQM implementation and self insurance program
- Evidence Based Medicine (EBM), an essential course, organized by National & Gulf Center For Evidence Based Medicine, September 7−8, 2005, ( which is one of the pillars we rely on as a reference in TQM implementation, approval and auditing providers claims).
- (Subspecialty Oriented Evidence Based Medicine Course) organized by National & Gulf Center for Evidence Based Medicine September 27th, 2005.
- (In-House Quality Awareness Seminar) December 20th, 2003.
- Cost Drive in Health Insurance (online course by HIAA).
- (International Symposium on Emergency Medicine Critical Care, and Neurological Emergencies), held at king Faisal Specialist Hospital & Research Center, Riyadh, November 12-22, 2006.
- (The First King Faisal Specialist Hospital and Research Center Geriatric Symposium) King Faisal Specialist Hospital and Research Center Riyadh, April 12-22, 2006.
- Attending most of the symposiums on Continuous Medical Education (CME).

Memberships
Organization Member since
­ NAHQ (National Association for Healthcare Quality), Illinois, USA July 2006
­ NGCEBM (National & Gulf Center of Evidence Based Medicine)
­ (EBM Economy Task Team), King Abdulaziz Medical City National Guard Health Affairs Riyadh, K.S.A September 2005


­ SAHI (Saudi Association for Health Informatics) March 2008


4. Computer Skills - CV/Resume Part 4 [Mandatory]
- Computer skills: Office (Word, Excel, Visio, Power Point), File Maker, Internet, Outlook, PDA, Minitab
5. Other Skills - CV/Resume Part 5 [Optional]
- Pubmed & national guideline clearinghouse websites user which are the basics of evidence based medicine.
- Fraud & Antifraud Practice Expert More than 5 years
6. Additional Information - CV/Resume Part 6 [Optional]
Languages
­ Fluent at English as a Foreign Language (EFL); both in speaking and in writing for daily communication.
­ Arabic is the mother tongue.


 

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Healthcare director, Medic, MBA, FAIHQ, CSSBB, MBBS
CV/Resume ID no.: 88860

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