Microsoft Office
Osama Nossier
Revenue Cycle Director
Cairo
Summary
As a self-driven, results-oriented physician with long experience and excellent track record in various medical, hospital and insurance fields and project management, and devising end-to-end operations and business solutions in various fields of healthcare delivery systems within multinational, local corporations and top hospitals groups. My goal has always been to work effectively as a member of a team of professionals with clear focus on both delivering high quality health services and business profit. I have a continuing interest in serving as a team leader in an organization to develop my career and to participate and lead the strategic planning for the future progress and development of the organization and achieving its objectives.
Overview
26
26
years of professional experience
4
4
Languages
Work History
Group Revenue Cycle Director
Cleopatra Hospitals Group
01.2020 - Current
- Direct an internal team to ensure accurate submission of all claims and timely collections occurs in accordance with all third party contract terms including, Commercial insurance, TPAs, direct contracts, and Public Insurance
- Actively collaborate with Hospitals and Corporate Office Finance teams to analyze reimbursement from all sources, including carrier reimbursement exception reporting, unbilled analysis and follow up pending claims analysis and denials management, billing activity for monthly financial reporting
- Assure maximization of cash collections through diligent and timely monitoring of all open accounts receivable balances
- Maintain and enhance billing policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies
- Prepare detailed analyses and reports of billing and accounts receivable activity and results, including performance matrices, bad debt expense, and AR days outstanding
- Monitors and report Payer’s performance, departmental and consultant performance from RCM perspective
- Manage for continuous improvements within the revenue cycle process
- Actively participates in pricing decisions and annual business plan setting
- Ensure consistent quality of the billing services by distributing and assigning duties and responsibilities to employees, ensuring skill levels are appropriate to the assigned tasks, and monitoring the department’s productivity
- Provide leadership, drive change, and facilitate process improvements
- Develop and monitor operating procedures and, where necessary, implement changes in workflow to improve productivity
- Conduct annual performance evaluations, make hiring decisions, and develop corrective action plans when necessary
- Interface with payers to resolve reimbursement issues collaborating closely with Payer Relations regarding contracting challenges
- Promote organizational efficiency, needed change and continuous quality improvement
- Identify and implement opportunities for automation and improved efficiency and organizational impact.
- Reduced outstanding accounts receivable balances by diligently monitoring aging reports and following up on overdue invoices.
- Maintained a high degree of accuracy in data reporting with regular reconciliation between general ledger accounts related to revenue cycle transactions.
- Increased revenue by streamlining billing processes and implementing effective collection strategies.
- Supported organizational growth initiatives through proactive involvement in budget planning and financial forecasting activities.
- Mentored junior staff members to develop their skills and advance within the organization''s revenue cycle management hierarchy.
- Ensured timely claim submission by effectively managing coding workflows within the department.
- Improved overall financial performance with consistent evaluation and implementation of revenue cycle best practices.
- Collaborated with cross-functional teams to identify areas for operational improvement within the revenue cycle process.
Medical Director
Metlife Egypt
01.2015 - 01.2020
- Develop tools and processes to critically evaluate and improve network effectiveness, including evaluation, proposals for improvement, resource requirements and organizational impact
- Leads and conducts the contracting process of providers, hospitals, ancillary providers and other support services, and evaluates the medical and financial aspects of the provider contracts
- Design and implements the Network strategy in concurrence of the overall company strategy
- Provides guidance on strategic plans, vision, and action plan development
- Achieves and maintains benchmarked utilization and cost management (UM) goals
- Creates and maintains programs to achieve selected utilization/cost and quality outcomes in collaboration with delegated medical groups
- Designing and applying best practices, leading & planning process improvement initiatives in various medical network operations
- Achieves and maintains benchmarked utilization and cost management (UM) goals
- Creates and maintains programs to achieve selected utilization/cost and quality outcomes in collaboration with delegated medical groups
- Revising and approving contracting prices and negotiating discounts as per the portfolio utilization/cost drivers and Medical Loss Ratio ensuring sustainable profitable P&L
- Working closely with the underwriting and actuarial departments in medical pricing activities and decisions to ensure P&L profitability
- Maintains up-to-date knowledge of new information and technologies in medicine and their application to the health plan
- Responsible and accountable for assuring appropriate health care delivery for the insured members and managing the health plans medical costs
- Provides professional leadership and direction in areas of Medical Management and Quality Improvement
- Designs and implements corrective action plans to address issues and improve the network performance
- Achieves and keeps benchmarked utilization and cost management (UM) goals
- Creates and maintains programs to achieve selected utilization/cost and quality outcomes in collaboration with delegated medical groups
- Participates in key marketing and sales activities
- Assures benefits plan conformance with legal, regulatory and company requirements.
Senior Medical Advisor - PPO Network
Metlife Egypt
01.2013 - 01.2015
- Management of provider, contracting and credentialing database implementation
- Develop documentation for system use and access
- Improve company-wide understanding and use of network resources
- In house resource for problem resolution and intervention
- Responsibility for company initiatives and project oversight as assigned
- Develop and maintain department and provider policy and procedures
- Assist internal departments with implementation of physician centered activities to meet company goals and objectives
- Track, follow up and report on network accountabilities.
Insurance and Marketing Executive Director - Strategy Team
Andalusia Group for Medical Services
01.2012 - 01.2013
- Setting, implementing and following up the strategic and action plans for all credit contracts, corporate, medical, community sales and marketing activities
- Additionally, was responsible for assessment and ranking of B2B businesses, corporate clients, negotiating rates and renewals
- Planning, benchmarking and implementing all services pricing activities and developing pricelists for the group’s hospitals
- Revenue cycle management and strategic planning in collaboration with the finance team
- Developing and implementing of KPI’s for corporate sales, health insurance and marketing departments and operations
- Billing process improvement, implementation and streamlining with focused denial analysis and management to ensure a consistent billing cycle
- Managing the receivables and collection activities to enhance cash flow
- Building the HR capacity, re-structuring and process re-engineering of insurance and marketing departments and operations.
General Manager
Port Ghalib Hospital - Marsa Alam
01.2011 - 01.2012
- Port Ghalib Hospital is a privately owned 60 beds hospital located 72 km south of Al- Qusseir in the heart of Port Ghalib Marsa Alam, Red Sea
- As a general manager, I assumed full responsibility of organizing goals, objectives, setting and achieving financial goals, the administrative functions of the hospital, delegating duties and establishing formal means of accountability on the part of subordinates through written reports and routine meetings with department directors
- Responsible for the day-to-day operational running of the hospital
- Additionally, I participated in defining, planning, and setting of strategic priorities for the direction of the hospital
- I led planning and management of workforce and human resource, service lines, finance, supply chain, marketing and business development, IT infrastructure and HIS
- This also included developing and implementing work policies and Standard Operational Procedures (SOPs)
- Specific duties include recruitment and retention of physicians, introducing new specialties and services according to market needs, overseeing quality improvement processes for efficient delivery of patient care, setting standards, oversight of budgets, creating financial and business strategies to assure fiscal viability and health
- Involved in public and community affairs, billing, collections, purchasing of equipment.
Medical Advisor - PPO Network
Metlife - Egypt Head Office
01.2010 - 01.2011
- Negotiated competitive and complex contractual relationships with providers according to predetermined internal guidelines and financial standards
- Worked cross-functionally to execute network strategies
- Maintained accountability for specific medical cost initiatives
- Responsible for understanding and managing medical cost issues and initiating appropriate action
- Provided sales and marketing support, and guidance with comprehension of applicable state legal regulations.
Prior-Authorization Doctor - Medical Claims Dep.
Metlife - Egypt Head Office
01.2008 - 01.2009
- Review pre-authorization and referral requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request
- Investigate member history, clinical history, and eligibility as appropriate; contact case managers and medical service personnel to gather further information
- Serve as advisor to team on pre-authorization reviews of cases with complexities falling outside of normal authorization protocols and guidelines.
Medical Manager - Red Sea Area - Hurghada
SCMG Medical Services
01.1999 - 01.2008
- Served a population of 3000+ Employees and 1800 Hotel Guests
- Clinical Responsibilities: Administered and provided primary care, Occupational health, provided emergency and other acute care, advising on disease prevention, Health education, arranging 24hour care provision, insuring confidentiality, administering vaccines, Training employees on CPR and first aid, emphasis on travel medicine, and establishing an emergency medical action plan
- Administrative Responsibilities: Case Management, maintains an inventory of supplies, communicates with patients, trains staff, setting an emergency medical action plan, ensures universal precautions, sets budget priorities, keeps medical records, performs a broad range of health insurance functions including, enrollment and eligibility, utilization management, member advocacy, PPO network management and contracting and claims review and payment in accordance with the Companies health plan and medical benefits
- Reporting to and function as a liaison between the management and the CEO.
Education
Professional Postgraduate Diploma - Healthcare and Hospital Management
American University in Cairo
Fundamentals of Health Insurance - undefined
AHIP Center for Insurance Education and Professional Development
Fundamentals of Health Insurance - undefined
AHIP Center for Insurance Education and Professional Development
MSc. Degree - Internal Medicine and Tropical Medicine
Cairo University
Bachelor of Medicine and Surgery - undefined
Cairo University
Skills
Business Relationship Management
Revenue Cycle Optimization
Cash Flow Management
Account resolutions
Denial Resolution
Revenue Enhancements
Billing cycle expertise
Claims Management
Budgetary analysis
Data Analytics
Affiliations
- Member of the Egyptian Society of Hepatology, Gastroenterology and Infectious Disease
- Member of the Universial Health Insurance Act Technical Committee
Trainings And Certificates
- The 7 habits of highly effective people (signature edition)
- The 4 Essential Roles of Leadership
- Tools of process control in Quality Management
- Six Sigma
- Health Economics
- KAIZEN: The R.A.P.I.D. Model for Process Improvement
- Business Skills Development
- Occupational Safety and Health Basic Training Program
- Occupational Safety and Health Advanced Training Program
Military Service
Exempted
Personal Information
- Date of Birth: 12/01/71
- Marital Status: Married
Projects
Provider Management Tool (Business Requirements/Assisted in Design/ Deployment) Utilization Management Tool Closed File Review Project (Fee table enhancement/Mapping/Training) eDocumentation file management system eClaims System Deployment eApprovals system Deployment Pharmacy Benefit Management Online System deployment Metlife mobile application Bizflow Process automation system (Business Requirements/Assisted in Design/Deployment) Clinisys Healthcare ERP system
Software
Microsoft Windows
Microsoft Power PI
Process Automation Systems
Clinisys Hospital ERP system
Timeline
Group Revenue Cycle Director
Cleopatra Hospitals Group
01.2020 - Current
Medical Director
Metlife Egypt
01.2015 - 01.2020
Senior Medical Advisor - PPO Network
Metlife Egypt
01.2013 - 01.2015
Insurance and Marketing Executive Director - Strategy Team
Andalusia Group for Medical Services
01.2012 - 01.2013
General Manager
Port Ghalib Hospital - Marsa Alam
01.2011 - 01.2012
Medical Advisor - PPO Network
Metlife - Egypt Head Office
01.2010 - 01.2011
Prior-Authorization Doctor - Medical Claims Dep.
Metlife - Egypt Head Office
01.2008 - 01.2009
Medical Manager - Red Sea Area - Hurghada
SCMG Medical Services
01.1999 - 01.2008
Professional Postgraduate Diploma - Healthcare and Hospital Management
American University in Cairo
Fundamentals of Health Insurance - undefined
AHIP Center for Insurance Education and Professional Development
Fundamentals of Health Insurance - undefined
AHIP Center for Insurance Education and Professional Development
MSc. Degree - Internal Medicine and Tropical Medicine
Cairo University
Bachelor of Medicine and Surgery - undefined
Cairo University