Dr.Hazem El-Hulw
KHOBER-KSA,The Eastern Province
Summary
Revenue Cycle Management and Medical Insurance professional with extensive experience in healthcare operations, insurance claims, and payer coordination. Achieved significant improvements, including reducing claim rejections from 40% to 11% and decreasing accounts receivable days from 105 to 60, through effective team leadership and targeted process enhancements. Focused on leveraging technical expertise and operational insights to drive revenue growth and enhance claim accuracy within healthcare organisations.
Overview
2
2
Languages
1
1
Certification
20
20
years of professional experience
Work History
Regional Revenue Cycle Management (RCM) Director
Al-Hokail Medical Group KSA&BAH
KHOBER, YARMUK
03.2024 - 10.2026
- Led RCM operations across six branches in Saudi Arabia and Bahrain, managing a team of 12 across claims, pre-authorisations, collections, denial management, reconciliation, and insurance contracting. Shared responsibility for insurance-related workflows with branch operations managers and reception teams.
- Reduced claim rejection rates from 40% to 18% in the first year and to 11% in the second year by addressing recurring technical and medical denial causes, improving clinical documentation and coding, and delivering targeted training to physicians and frontline staff.
- Helped increase revenue over two years by introducing new services, expanding relationships with insurers, and improving coordination between clinical, operational, and RCM teams.
- Reduced accounts receivable days from 105 to 60 for insurers without early payment agreements through closer follow-up, reconciliation, and resolution of outstanding claims.
- Aligned claims submission schedules with early payment agreements to ensure timely submission by 5th of each month and collection within 10 working days for participating insurers.
- Standardised price lists and service-code mapping to meet NPHIES requirements, securing insurer validation of code coverage and agreed prices, which reduced billing discrepancies and prevented avoidable rejections.
- Coordinated transition to Oasis HIS and DRG activation, implementing system and workflow improvements that enhanced claims accuracy and operational efficiency.
- Trained physicians on insurance requirements, clinical documentation, and medical denial prevention, while coaching reception and authorisation teams to identify and correct issues before claims submission.
Head of Insurance Claims Office
ProCare Hospital
KHOBER, Olia
01.2020 - 02.2024
- Managed the hospital’s insurance claims submission function, overseeing claim preparation and submission in line with payer requirements.
- Transitioned claims submission from Waseel and DHS to direct submission through NPHIES, streamlining billing data and submission workflows for improved accuracy.
- Established system controls over service mapping and pricing to identify configuration discrepancies, minimising billing and submission errors.
- Held full responsibility for insurance-related HIS configuration, translating insurer contracts, policy benefits, and billing requirements into system rules.
- Mapped internal hospital service codes to NPHIES codes and insurer-approved price lists, ensuring alignment between billed services, code definitions, and contractual coverage.
- Configured contracted package deals, including agreed rates, included services, exclusions, and billing conditions, to ensure package billing reflected each insurer’s agreement.
- Implemented the Table of Benefits (TOB) for individual insurance policies and linked each policy to its applicable coverage rules, benefit limits, deductibles, co-payments, exclusions, and authorisation requirements.
- Defined and maintained benefit categories, business rules, and contractual terms within the system, ensuring that each policy’s TOB was applied consistently during billing and claims processing.
- Played a key role in Procare Hospital’s NPHIES Wave 1 implementation in Saudi Arabia, managing insurance configuration and code-mapping readiness for the transition.
Billing Supervisor
ProCare Hospital
KHOBER, Olia
03.2018 - 12.2019
- Supervised insurance billing activities and policy coding, ensuring billing records reflected the applicable insurance policy and payer requirements.
- Monitored staff preparing and submitting claims, coordinating workloads and tracking submission progress across assigned payers to ensure timely processing.
- Oversaw claims submission to third-party administrators (TPAs), including TCS, SNC, and GlobeMed, in line with each administrator’s submission requirements.
- Coordinated policy coding, billing, and claims submission activities to streamline monthly submissions and resolve issues impacting claim readiness.
- Managed Ministry of Health claims for Ehalati referral program, overseeing preparation and monthly submission of long-term care (LTC) claims to meet compliance standards.
Billing Accountant
Procare Hospital
KHOBER, Olia
01.2016 - 02.2018
- Reviewed approximately 6,000 IP and OP claims per month, representing SAR 3.5–4 million in billed value, checking accuracy and completeness before submission.
- Verified patient and policy details, eligibility on date of service, benefit coverage, deductibles, and co-payments to ensure compliance with billing regulations.
- Checked authorisation numbers, validity periods, approved services, quantities, and limits against billed services, ensuring accuracy for inpatient admissions and extensions.
- Validated service codes, code mapping, contracted prices, discounts, and invoice calculations to identify and correct billing discrepancies.
- Managed pre-submission billing and technical claims review for both inpatient (IP) and outpatient (OP) services for MedGulf, the hospital’s largest insurance account at the time, and the SABIC direct account.
- Reviewed supporting attachments for IP and OP claims, including discharge summaries, operative reports, clinical reports, and investigation results, ensuring they matched the billed services and approvals.
- Identified duplicate charges, missing information, coding discrepancies, and services outside the approved scope, coordinating corrections before submission.
- Prepared claims per payer requirements and submission deadlines, focusing on minimising technical rejections through thorough review processes.
Approval Officer
Procare Hospital
KHOBER, Olia
09.2014 - 12.2015
- Managed medical pre-authorisation requests across insurers and TPAs, including Bupa, Tawuniya, MedGulf, Takaful Al Rajhi, Malath, SNC, TCS, GlobeMed, and AXA.
- Transitioned from managing outpatient (OP) approvals to overseeing inpatient (IP) authorisations, including admissions, procedures, and length-of-stay extensions, enhancing overall approval process efficiency.
- Verified insurance eligibility, policy benefits, coverage limits, and authorisation requirements before submitting requests.
- Reviewed requests for completeness and compiled necessary clinical reports, investigation results, treatment plans, and cost estimates to facilitate timely medical approvals.
- Coordinated with treating physicians to obtain further clinical details and medical justification when requested by insurers, ensuring responses addressed the payer’s queries.
- Submitted and tracked authorisation requests through each payer’s dedicated portal before the transition to NPHIES, following payer-specific requirements and response timelines.
- Coordinated follow-ups on pending, partially approved, and declined requests, ensuring timely clarification and reconsideration to minimise delays in patient care.
- Checked approval validity, authorised services, quantities, and financial limits, and communicated approval details and conditions to clinical and billing teams.
- Maintained accurate authorisation records and linked approvals to the relevant patient encounters to support billing and subsequent claims submission.
ADT Officer
ProCare Hospital
KHOBER, Olia
06.2013 - 08.2014
- Verified patient identification, insurance eligibility, and admission authorisation to ensure compliance with admission procedures.
- Managed inpatient admissions, discharges, and transfers, maintaining accurate patient registration and encounter details in the hospital information system.
- Prepared admission documentation, explained administrative and financial requirements to patients and families, and coordinated deposits or patient payments.
- Coordinated bed allocation and availability with nursing teams and clinical departments, arranging room assignments and transfers according to patient needs and eligibility.
- Reviewed medical records against posted charges to identify missing services, duplicate entries, and billing discrepancies before discharge.
- Coordinated with nursing, pharmacy, laboratory, radiology, and other departments to confirm that services, medications, and consumables were accurately reflected in the final bill.
- Worked with billing and insurance teams to verify patient financial responsibility, including deductibles, co-payments, and non-covered services, and completed financial clearance.
Receptionist Supervisor
ProCare Hospital
KHOBER, Olia
02.2012 - 05.2013
- Supervised daily outpatient reception activities, coordinating staff assignments and patient flow across clinics.
- Trained and supported reception staff on registration procedures and appointment handling, enhancing professional patient communication and ensuring consistent service delivery.
- Managed patient check-in and queue arrangements, working with physicians and nursing teams to address delays and maintain an organized clinic flow.
- Coordinated outpatient physicians’ schedules and appointment bookings, ensuring timely communication of cancellations and changes to patients and relevant departments.
- Opened and updated patient files, verified identification and contact details, and maintained accurate records while preventing duplicate registrations.
- Verified insurance details and coordinated with the insurance and approval teams to confirm eligibility, coverage, and authorisation requirements before consultations and services.
- Resolved patient concerns and appointment-related complaints, escalating issues to management or clinical teams when required.
VIP Coordinator
ProCare Hospital
KHOBER, Olia
04.2011 - 01.2012
- Managed the dedicated VIP patient service, providing personalised coordination throughout each visit, from greeting patients at the hospital entrance to escorting them on departure.
- Acted as the main point of contact for VIP patients and their families, responding to enquiries and keeping them informed throughout their hospital journey.
- Scheduled consultations, investigations, and follow-up appointments, coordinating with physicians and outpatient clinics to accommodate patient needs and availability.
- Prepared visit arrangements, coordinating registration, insurance approvals, and billing requirements to ensure a seamless patient experience.
- Coordinated with nursing, laboratory, radiology, pharmacy, and other departments to organise services and minimise unnecessary waiting and movement between departments.
- Followed up on the availability of test results and service completion, ensuring results reached the treating physician and arranging clinical feedback or follow-up appointments.
- Handled special requests and service concerns with discretion, resolving coordination issues and escalating critical matters to ensure patient satisfaction.
- Confirmed completion of appointments, prescriptions, reports, and administrative requirements before departure, ensuring compliance with patient privacy and confidentiality standards.
ER Receptionist
ProCare Hospital
KHOBER, Olia
01.2010 - 03.2011
- Handled emergency department reception and patient registration during shift-based operations, working under pressure with accident cases, ambulance arrivals, and patients brought in by the Saudi Red Crescent.
- Registered emergency visits, opened patient files, and verified identification and demographic information, coordinating with clinical staff to ensure administrative procedures supported timely patient assessment.
- Worked closely with triage nurses and emergency physicians to support patient flow and maintain accurate registration and encounter records.
- Assisted patients and families with registration, admission procedures, and administrative enquiries, communicating calmly and respectfully during stressful situations.
- Maintained accurate records of admissions, transfers, and discharges, ensuring outstanding administrative tasks were clearly communicated during shift handovers.
- Prepared admission paperwork for hospitalised patients following physician’s decision, coordinating bed availability and receiving arrangements to facilitate smooth transfer to inpatient wards.
- Coordinated with nursing teams and the relevant departments to support patient transfers from the emergency department to the assigned ward.
- Collected insurance information and liaised with approval and billing teams to ensure compliance with emergency coverage and inpatient authorisation requirements.
- Protected patient confidentiality and escalated identification, registration, and administrative issues to the appropriate teams.
Underwriting Officer – Medical, Property & Fire In
Allianz Egypt
Cairo, Dokki, Giza, Egypt
02.2007 - 12.2009
- Reviewed insurance applications and supporting documents for medical, property, and fire insurance, ensuring completeness and accuracy to facilitate timely processing.
- Evaluated medical reports submitted with health insurance applications to enhance the underwriting process.
- Calculated insurance premiums and prepared accurate quotations based on applicable rates, coverage terms, and underwriting guidelines to support informed decision-making.
- Issued insurance policies, renewals, and endorsements, ensuring policy documents accurately reflected the agreed coverage, premiums, and customer details.
- Processed policy amendments and maintained accurate records of issued documents and changes throughout the policy period.
Education
Certificate of Completion - Artificial Intelligence & Business Applications
Academy of Bristol
Wenlock Road, London, England01-2026
Certificate of Completion - Leadership & Decision Making
Academy of Bristol
Wenlock Road, London, England01-2026
Certificate of Attendance - SBS V3 & Non-Admitted Bundles
Council of Health Insurance (CHI) & Selat Business
Saudi Arabia CHI & Selat Business Solutions01-2025
Professional Doctorate - Medical Insurance Management
Nevada University
N. Virginia St. Reno NV 89557 USA01-2025
Certificate of Completion - Clinical Terminology & Health Informatics
SNOMED International
SNOMED International01-2025
Certificate of Completion - Project Management
Academy of Bristol
Wenlock Road, London, England01-2025
Certificate of Attendance - Clinical Coding Audit & AR-DRG
Council of Health Insurance (CHI)
Saudi Arabia CHI01-2024
Certificate of Completion - Healthcare Financing & Diagnosis-Related Groups (DRGs)
NAWA
NAWA01-2023
Program Diploma - Financial Management
International Business Management Institute (IBMI)
Berlin, Germany01-2023
Bachelor of Arts (BA) - Psychology
Faculty of Arts
Tanta University01-2006
Skills
1Revenue Cycle Management (RCM)
2Medical Insurance Operations Management
3Denial & Rejection Management
4Denial Root Cause Analysis & Prevention
5Insurance Claims Review & Submission
6Accounts Receivable & Collections Management
7Payer Reconciliation & Settlement
8Insurance Contract Management & Pricing
9Medical Coding Review & Code Mapping
10NPHIES Implementation & Claims Integration
11HIS Insurance Configuration & Billing Controls
12Insurance Policy & Table of Benefits (TOB) Configuration
13Prior Authorization Management
14Inpatient & Outpatient Billing
15DRG Implementation Support
16Revenue Growth & Process Improvement
17RCM Performance Analysis & KPI Reporting
18Multi-Branch Operations & Team Leadership
19Physician & Staff Training
20Payer Relations & Negotiation
21Revenue cycle management
22Medical coding
23Claims processing
24Claims Workflow Optimisation
Languages
English
Upper Intermediate
B2
Arabic
Proficient
C2
Certification
• Artificial Intelligence in Business — Academy of Bristol | October 2026
• Leadership and Communication — Academy of Bristol | October 2026
• Personal Leadership and Decision Making — Academy of Bristol | June 2025
• Project Management — Academy of Bristol | June 2025
• SNOMED CT Foundation Course — SNOMED International | March 2025
• General Overview, Methodology & SBS Standards Review: Non-Admitted Bundles Workshop, in preparation for SBS V3 Implementation — Council of Health Insurance (CHI) & Selat Business Solutions | February 2025 | Certificate of Attendance
• Clinical Coding Audit Workshop, in preparation for AR-DRG Implementation — Council of Health Insurance (CHI) | July 2024 | Certificate of Attendance
• Financial Management — International Business Management Institute (IBMI) | July 2023 | Program Diploma
• DRGs – The Funding Model Healthcare & Quality — NAWA | 10-hour course | Certificate of Completion
Hobbies and interests
• Computers and technology
• Football and handball
• Continuous learning and professional development
References
• Mr. Abdul Hamid Al-Turkmani
Mobile: 0562844442 / 0504805331
• Mr. Mahmoud Attia
Mobile: 0503813964
• Mr. Ayman Saudi
Mobile: 0545677887
Accomplishments
• Reduced insurance claim rejection rates from 40% to 18% within the first year and to 11% by the second year through denial root cause analysis, physician and reception staff training, improved clinical documentation, and corrections to coding and system configuration.
• Reduced accounts receivable days from 105 to 60 for insurers without early payment agreements by improving claims follow-up, resolving outstanding issues, and coordinating reconciliation and collection activities.
• Established a monthly claims submission schedule by the 5th of each month for insurers with early payment agreements, enabling collection within 10 working days and improving cash flow.
• Played a key role in two Oasis Plus HIS implementations, at Al-Hokail Medical Group and Procare Hospital, including integration with NPHIES. Responsibilities covered insurance system configuration, internal-to-NPHIES code mapping, payer contracts, policy benefits, pricing, and billing controls.
• Supported Procare Hospital’s transition during NPHIES Wave 1, moving claims submission from separate platforms, including Waseel and DHS, to direct submission through NPHIES.
• Standardized insurance price lists and strengthened code mapping controls, validating service coverage and agreed prices with insurers to address discrepancies before claims submission.
• Contributed to revenue growth over two years by introducing new services, expanding relationships with insurers, and coordinating with clinical and operational teams to support service delivery and accurate billing.
• Strengthened operational consistency across five branches in Saudi Arabia and one in Bahrain, managing a team of 12 across claims, approvals, collections, denial management, reconciliation, and contracting.
• Delivered practical training to physicians and reception teams on insurance requirements, approval processes, clinical documentation, and recurring rejection causes, helping teams prevent errors at the source.
Additional Information
• Available to start immediately.
• Willing to relocate and travel for work.
• Hold valid Egyptian and Saudi driving licences.
Timeline
Regional Revenue Cycle Management (RCM) Director
Al-Hokail Medical Group KSA&BAH
03.2024 - 10.2026
Head of Insurance Claims Office
ProCare Hospital
01.2020 - 02.2024
Billing Supervisor
ProCare Hospital
03.2018 - 12.2019
Billing Accountant
Procare Hospital
01.2016 - 02.2018
Approval Officer
Procare Hospital
09.2014 - 12.2015
ADT Officer
ProCare Hospital
06.2013 - 08.2014
Receptionist Supervisor
ProCare Hospital
02.2012 - 05.2013
VIP Coordinator
ProCare Hospital
04.2011 - 01.2012
ER Receptionist
ProCare Hospital
01.2010 - 03.2011
Underwriting Officer – Medical, Property & Fire In
Allianz Egypt
02.2007 - 12.2009
Certificate of Completion - Artificial Intelligence & Business Applications
Academy of Bristol
Certificate of Completion - Leadership & Decision Making
Academy of Bristol
Certificate of Attendance - SBS V3 & Non-Admitted Bundles
Council of Health Insurance (CHI) & Selat Business
Professional Doctorate - Medical Insurance Management
Nevada University
Certificate of Completion - Clinical Terminology & Health Informatics
SNOMED International
Certificate of Completion - Project Management
Academy of Bristol
Certificate of Attendance - Clinical Coding Audit & AR-DRG
Council of Health Insurance (CHI)
Certificate of Completion - Healthcare Financing & Diagnosis-Related Groups (DRGs)
NAWA
Program Diploma - Financial Management
International Business Management Institute (IBMI)
Bachelor of Arts (BA) - Psychology
Faculty of Arts