Dr. Hossam Khartoum

Provide strategic Pre-Authorization Business Development initiatives, optimizing processes and driving significant operational enhancements within a leading health insurance provider.

• Directed the creation and enhancement of Pre-Authorization department functions, significantly improving operational efficiency and cross-departmental alignment.
• Successfully implemented automation solutions for Dental, Optical, and Pharmacy Benefit Management (PBM) services, reducing turnaround times (TAT) and optimizing costs.
• Managed end-to-end Pre-Authorization projects, collaborating with vendors and technical teams to deploy solutions that enhanced service quality and compliance.
• Monitored Pre-Authorization transactions via NPHIES Platform, providing critical insights and reports that informed strategic quality and operational decisions.

Provided senior-level oversight for Pre-Authorization business development, delivering key insights and solutions to enhance operational performance and compliance.

• Monitored and analyzed Pre-Authorization transactions using the NPHIES Platform, generating critical reports that guided quality and operational decision-making.
• Spearheaded the development and enhancement of Pre-Authorization projects, working with cross-functional teams to implement effective solutions.
• Collaborated with vendors and internal departments to deploy business process improvements, focusing on reducing TAT, cutting costs, and elevating service quality.
• Contributed to the successful automation of key services including Dental, Optical, and Pharmacy Benefit Management (PBM), streamlining workflows and improving efficiency.

Managed and processed a high volume of medical requests, ensuring strict adherence to regulatory guidelines and clinical standards as a Senior Pre-Authorization Physician.

• Processed a high volume of outpatient and inpatient medical requests daily, ensuring strict compliance with CCHI, Medical, and PIC policies.
• Accurately aligned all medical requests with ICD-10 codes, maintaining data integrity and facilitating efficient claims processing.
• Ensured medical care provided to members consistently met updated clinical guidelines, enhancing patient safety and quality of service.
• Provided supervision and education to junior colleagues, fostering adherence to best practices and regulatory compliance.

Processed and managed medical insurance requests, ensuring adherence to updated policies and clinical guidelines.

• Processed outpatient and inpatient medical requests in accordance with updated CCHI, Medical, and PIC policies, ensuring compliance and efficiency.
• Ensured medical care provided to members aligned with clinical guidelines, contributing to high-quality patient outcomes.

Oversaw medical approval processes, ensuring compliance with regulatory frameworks and clinical standards while contributing to team development.

• Managed the processing of outpatient and inpatient medical requests, aligning them with CCHI, Medical, and PIC policies.
• Ensured accurate alignment of all requests with ICD-10 codes, streamlining approval workflows.
• Verified medical care provided to members consistently met updated clinical guidelines, enhancing service quality.
• Provided supervision and education to junior colleagues, improving team competency and adherence to best practices.

Processed medical approval requests, ensuring compliance with industry standards and clinical guidelines.

• Processed outpatient and inpatient medical requests in strict accordance with CCHI, Medical, and PIC policies.
• Aligned all medical requests with ICD-10 codes for accurate documentation and processing.
• Ensured medical care provided to members adhered to updated clinical guidelines, maintaining high standards of patient service.

Managed the health and fitness of professional racers, providing essential medical support and emergency care.

• Oversaw the physical fitness and medical readiness of racers, implementing health protocols.
• Provided immediate first aid care during racing events, ensuring rapid response to injuries.

Provided comprehensive primary medical care to factory workers, addressing diverse health needs and promoting occupational well-being.

• Treated patients in industrial compounds, managing a wide range of medical conditions among factory workers.
• Focused on preventive care and early intervention to maintain a healthy workforce.

Completed comprehensive medical internships across multiple specialties, gaining foundational clinical experience in a leading research hospital.

• Rotated through Pediatric Department (Allergy Immune, General Pediatric, Pediatric Cardiology) for 3 months, assisting in diagnosis and patient management.
• Gained 2 months of experience in the Surgery Department (Cardiology, Urology), supporting surgical procedures and post-operative care.
• Completed a 3-month rotation in the Internal Medicine Department (Rheumatology, General Medicine, GIT), developing diagnostic and treatment skills.

Undertook medical internships in specialized departments, building practical clinical skills in a hospital setting.

• Completed a 3-month rotation in the OBS/GYN Department, assisting in obstetric and gynecological patient care.
• Gained 1 month of experience in Plastic & Thoracic Surgery, observing and assisting in surgical procedures.