Revenue Cycle Manager

Job Description

• Strategize and establish Price list for all Healthcare services provided in coordination with
• Healthcare Operations and Finance both for cash payments and Insurance Payments in compliance with DHA regulations.
• Attract Insurance Providers, Third Party Administrators, and Corporates and Government establishment and negotiate for effective business agreement for direct billing with calculated discounts.
• Establish and monitor Contract Management with Providers ensuring compliances and credentials.
• Develop and establish effective Patient Scheduling and Registration process ensuring Patient satisfaction and Optimization of Healthcare resources.
• Establish timely preauthorization monitoring processes for both Outpatient and Inpatients.
• Develop protocols, train staff and ensure zero error environments in document verification,
• Insurance eligibility and document collection to minimize claim denials.
• Establish Claim capture process by effective training and monitoring with proper internal controls.
• Develop protocols, train staff and ensure accurate coding, documentation, timely charging and claim submission.
• Provide sufficient documents for Finance to raise billing and support the collection process.
• Establish effective reconciliation and resubmission analysis with insurance companies.
• Supervise all claims and reconciliations to ensure completion of the process in a timely manner.
• To ensure effective analysis of the claims and quality assurance audits are performed.
• Handle effectively network and price management.
• Analyze Financials in terms of revenue cycle management and take effective decisions and implementation.
• Ensure all Revenue cycle processes lead to effective Cash Flow Management.
• Review Contracts, Price list, Costings, Protocols, Internal Controls, Processes, Unit and Staff performances periodically.
• Establish Healthy relationships with providers and inter-depts. and the team with proper communication and regular meetings and follow-ups.
• Focus mainly on P / L for all processes.
• Hire, Train, Develop, and provide career paths for the team members ensuring the department goal is achieved in line with Business Goals.
• Develop and implement strategies to optimize revenue generation, minimize payment delays, and reduce denials. Monitor key performance indicators (KPIs) such as accounts receivable, revenue cycle time, and denial rates.
• Develop KPIs on the Unit level, Function level, and Individual level with a reasonable matrix and monitor effectively to ensure high-performance in environment and deliverables.
• Coordinate with other departments to synchronize the revenue cycle functions effectively.
• Provide Management Information System (MIS) reports to the Senior Management on   daily, weekly, and monthly basis.