SAMIR ELMETWALY (MBA)

MD-CPC-CDIP progressing

*** ********** **. *******, ** 75040

214-***-**** email LinkedIn

Clinical Documentation, Coding Educator/Risk Adjustment Determined, goal-oriented Sales Management professional with a proven track record of sales, account management, sale training and leadership. Inspirational, energetic, and passionate communicator, able to lead teams to improved performance and superior results. Strategic thinker, skilled at identifying emerging opportunities and capturing greater market share. Adept at developing and forging lasting profitable relationships. Outstanding multitasking, problem-solving, collaboration, business planning and tactical execution skills.

Clinical Documentation.

Coding Auditor.

Risk Adjustment.

EPIC, eCw,FPC,Athena user.

Revenue.

Strategic thinking.

Team Leadership.

Contract Negotiations

Leadership

Communication

Talent Acquisition

Payer/Gov. Reimbursement

AGILON HEALTH DALLAS TX USA 10/2022-PRESENT

Clinical Documentation coding integrity.

Review, analyze patient charts for improving the overall quality and completeness of clinical documentation.

Applying knowledge of medical terminology and procedures to evaluate clinical documents.

Audit patient charts to ensure accurate coding.

Validate DRG and Demonstrate knowledge, documentation opportunities, and clinical documentation requirements.

Collecting medical information from healthcare providers and updating medical records.

Verifying the accuracy of patient medical information and obtaining missing information

Monitoring diagnoses, treatments, and follow-up entries in medical records VILAGE MD DALLAS TX USA 2021-2022

Clinical documentation accuracy coder.

Review, analyze patient charts, identify missing, new and gap opportunities for improved coding accuracy.

Ensure compliance with established coding guidelines,3rd party reimbursement policies, regulations, and accreditation guidelines.

Audit patient charts to ensure accurate coding.

Queries and educates medical providers to obtain greatest possible diagnostic specificity and present on admission status to accurately reflect the patient’s condition in the medical record.

Demonstrates knowledge of documentation requirements and guidelines that recognize DRG payer issues and improves the overall quality and completeness of clinical documentation. Maintain awareness of and works to facilitate optimum outcomes in the CDI program and compliance goals.

Works with internal EMR to recommend accuracy in documentations and diagnosis.

Collaborates with technology team to improve electronic documentation of all clinical conditions during encounters.

AREAS OF EXPERTISE

PROFESSIONAL EXPERIENCE

Samir Elmetwaly 214-***-**** ad3qlz@r.postjobfree.com page two HUMANA SAN ANTONIA TX USA 2019-2020

Coding Auditor Risk Adjustment IPA.

MRA-Texas IPA. Certified professional coder managed risk adjustment for MA with detailed reviews patient’s chart.

CPT & ICD-10-CM expert code with potential medical reimbursement experience.

Solid platform with HTA & health authorities, Payer/insurance coverage experience with Medicare, Medicare Advantage, Commercial and Medicaid plans.

Analyze, interpret and abstract data/documentation.

Identify HCC improvement opportunities and provide feedback to physician on proper clinical documentation, compliance and coding guidelines.

Well organized, problem solving, time management. Detailed and result oriented. MSD (MERCK SHARP & DOHME) JEDDAH, SAUDIARABIA / EMEA 2006 – 2018 National Sales Manager, 2006 – 2018

Worked in specialty hospital dedicated to MOH tasked with solving the EMEA product issue - responsible for Immunology (Remicade), Virology (Peginteron), Anti- infective (Tienam, Cancidas, Esmeron), Respiratory & Diabetes (Singular & Januvia) & HIV.

Managed specialty Virology, and HIV line products achieving outstanding performance awardation in MOH through SGH33&SGH34 for inclusion of new molecule Bocebrevir in institutions hospitals.

Responsible for building sales and customer relations team from the ground-up including hiring, training, developing and mentoring – achieving organizational goals.

Established action plan and worked closely with key clients to develop and maximize consumption.

Retained Esmeron in the MOH sector to maximize consumption.

Negotiated the inclusion of Cancidas in MOH securing $600K and exceeded breakeven point.

Developed revenue and played a key role in increasing monthly revenue from 0 to $60K.

Negotiated the inclusion of Bridion in MOH and secured $200K as first inclusion either in the MOH or institution in the kingdom (Saudi-Arabia).

Forged strong profitable relationships that drove revenues by numerous, repeat, high dollar purchases.

Executed (CRM) for field activity expectations including sales activity and investment in medical education programs.

MBA, Marketing/Management, American University of London, London, UK 2009. M.D.: Medicine, Cairo University, Egypt 1997.

Six Sigma, LinkedIn 2018.

CPC-Medical Coding, Richland College, Dallas, TX 2018. EDUCATION / TRAINING / CERTIFICATE

PROFESSIONAL EXPERIENCE - Continued

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