Mohab Fawzy Email & Phone Number

Cairo, Cairo Governorate, EG

Egypt

• Responsible for planning, designing, directing, and executing performance improvement work in alignment with the Value Triple Aim (Quality, Service and Cost Excellence)
• Chairing the Data Governance Committee aimed to monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data.
• Directed the selection and implementation of a new analytics platform that reduced data processing time by 50% and increased data accuracy by 35% through automation and standardization of ETL processes
• Have led & driven Digital Health Solution Vendor evaluation & selection for our Hospital Group (BRD, RFP, UAT, Final Proposals Evaluation & Scoring)
• Championed an analytical framework that enabled our Hospital Group to identify 140+ high-value clients based on a lifetime value rather than quarterly revenue contribution with estimated increased retention rates by 55%
• Developed the Operating Model for a Population Health Management Program which is estimated to increase reach to +500k Patients leading to better coordinated care and compliance in addition to an expected Net Profit.

Cairo, Egypt

• Responsible of the realization of the Business Architecture of Egypt’s Universal Health Insurance & Care Program through depicting the hierarchical decomposition of Major Business Functions at the highest level of the.
• Functioned as the primary business liaison between the client, operations and the technical team throughout the project cycle.
• Led comprehensive and detailed JAD (Joint Application Development) Sessions aimed at functional requirements walkthrough for all functionalities (Beneficiary Enrolment-Network Management-Patient.
• Created Artifacts such as Use Cases, Activity Diagrams and sequence diagram using MS Visio.
• Supervised the Phasing of the Claims Management Module Delivery starting with EDI (Electronic Data Interchange) towards Full Healthcare Interoperability Solution using HL7 FHIR Standards.
• Assisting the Product Manager in release plans creation and tracking. Feature Acceptance Performing. Creation of common business scenarios with usage of released features.

Cairo, Egypt

• Responsible of the Utilization Management of Inpatient & Outpatient Services based on medical necessity, appropriateness of care criteria and the policy wordings in addition to ensuring medical underwriting is.
• Established a fit of purpose Organization of the Medical Department composed of 16 Medical Reviewers through a restructuring based on Claim Type (Inpatient-Outpatient), Channel (Online-Offline), Customer Segment.
• Introduced a Customer Segmentation Protocol to identify VIP Policy Holders with higher priority in the SLA (based on Size of the Client-LR-# of years with Mednet-Time to renewal-Strategic Importance of the client)
• Achieved a breakthrough Operational Efficiency in managing Outpatient requests through revamping System Business Rules Configurations (Medical-Technical) + Application of Auto-Routing criteria for Offline Requests +.
• Implemented Clinical Guidelines for the top Inpatient Surgical & Non-Surgical Conditions in addition to the most frequently utilized Outpatient services.
• Generated a new Revenue Stream through creating a Regional Hub for streamlining Service Mapping & Drugs Classification across all Mednet Business Units in the Region.

Al-Riyadh Governorate, Saudi Arabia

• Responsible of developing and implementing the strategic direction of the Provider Network Management team in accordance with financial, regulatory, operational and quality objectives. Managing a Network of +1,000.
• Set up the Provider Relations & Network Management Department, leading and training a team of 6 Network Managers, 5 Provider Support Managers and 10 Hospital Delegates.
• Achieved a breakthrough Cost Savings Milestone amounting to an Annualized Impact of SR 33M (i.e 9.8% of the Total Annual Net billed)
• Achieved a Cost Avoidance target of SR 11.9M through negotiation of better terms with our Key Providers.
• Introduced the Episodic Based Payment Model agreeing with + 40 Providers contributing by +20% of the Total Annual Net billed.
• Led a Partnership Agenda with pre-selected Key Providers in order to place Al Rajhi Takaful as the Payor of Choice.

Jeddah Governorate, Saudi Arabia

• Managed a network of Medical Providers with an annual spend amounting to SR 7.3bn, creating new network structure to drive more profit through professional pricing and network design of the providers to achieve.
• Set up the Provider Network Management Department; recruited and coached a team of 3 professionals who are focused on partnership with providers and driving cost effective management of healthcare benefits
• Standardized the pricing process through setting benchmark cost for every service based on the Provider tier- Location-Practice Type.
• Established a Value Based Purchasing Model through Bundled Payments & Reverse E-Auctioning of Medical Services, creating Preferred Network of Providers in each region incentivized by exclusivity and higher volume.
• Led a Cost Avoidance Program to minimize the impact of inflation of medical costs by less than 1.5%.
• Conducted a holistic Network Revamp through the creation of a Risk Cost Analysis tool to define the appropriate allocation of providers to specific tiers through adjustment of Case Mix - Inpatient& Outpatient.

Jeddah Governorate, Saudi Arabia

• Managed the delivery of the overall efficiency and productivity agenda of Bupa Arabia through the re-engineering of the major and key processes in Sales & Operations in order to ensure that all the activities within.
• Led the Provider Partnership Project which is targeted to bend the medical inflation curve by 5%, drive Service & Clinical Excellence in order to improve both the patients’ experience and clinical outcomes through a.
• Implemented a Process Change to the Fulfillment Material Purchasing of Beneficiary Cards through: Selecting & Signing Off two suppliers per region based on a set of KPIs- Creating a Standardized Cost Matrix composed of.
• Structured the Operating Model of a Health Coaching Program entailing: Chronic Disease management, Wellness & Shared Decision Making. The realized impact after one year of Implementation was increased Customer.
• Re-designed the delivery system of the Health Coaching Program with the utilization of Home Based Doctors, Automation & IVR Integration
• Identified the inefficiencies in the (As Is) Claims & TQM value chains and planned the (To be) states with a realized efficiency of 40% in turnaround time and resource consumption through automation, eliminating Non.

Jeddah Governorate, Saudi Arabia

Managed financial & operational functions for the division including Claims Control Unit, E-claims,Technical Audit & Reconciliation. Assisted in determination of operation goals/plans and financial support, developed reports and analyzed division financials - Led a team of 74 Claims personnel responsible for a SAR 1.8 billion Claims Cost Management plan..

Jeddah Governorate, Saudi Arabia

- Managed the adjudication of the Inpatient claims worth SAR 10m.- Completed the Reimbursement Policy Renewal.- Participated in development of the EFT (Electronic Funds Transfer) business case which reduced the Member’s Reimbursement turnaround time from 10 days to 3 days. - Enhanced Quality Control measures in the Reimbursement Operations which promoted a.

Cairo Governorate, Egypt

- Controlled a budget of one million EGP allocated to the Claims Cost Center.- Managed a team of ten physicians responsible for claims adjudication, that is auditing and reviewing hospital invoices from the medical point of view, concerning in-patient and out-patient services provided to our clients.- Evaluated the providers at the end of every month from.

Cairo Governorate, Egypt

- Monitored in-hospital services (patients, consultants and hospitals).- Documented (filling and archiving) second approvals- External auditing (using written and dated reports).- Followed the patients' medical progress.- Evaluated the services provided by the consultant and the hospital from the medical point of view.- Provided advice regarding the.

Master Of Business Administration (Mba), Business Analytics, 3.17

Post Graduate Diploma, Total Quality Management In Healthcare Reform, A

M.B.B.Ch, Medicine & Surgery