Revenue Cycle Manager

Description

Location:

Lusail, Qatar

Experience:

7-13 years, Full-time, Recruitment Job

Job Title:

Revenue Cycle Manager

Reporting To:
Head of Finance

Position Summary:

The Revenue Cycle Manager ensures the efficient and smooth processing of patient billing, pre-authorization, proper coding, insurance claims submission and resubmission, and recovery through effective liaising with insurance companies while maximizing patient satisfaction by leading the insurance operations with the objective of streamlining the process. Responsible for timely insurance claims submission and pre-authorization processing, reducing the insurance rejections, managing insurance contracts and benefits, overseeing the insurance operations and designing, implementing and training AMNM Day Surgery Doctors and other relevant stakeholders on insurance policies and protocols.

• Oversight of revenue cycle management of AMNM.
• Manage and negotiate contracts with insurance companies to obtain recognition as a service provider.
• Liaise with insurance companies regarding eligibility, payments, reconciliations, service additions to maximize the profitability of the business.
• Review insurance claims to ensure accuracy according to agreement prior to dispatch to respective insurance companies within stipulated timeline.
• Ensure proper coding – CPT, ICD, HCPCS, DRG codes as applicable.
• Perform internal audit and review of outpatient and inpatient files, billing and claims.
• Track pending receivables and ensure payments are received from payors within contractually agreed timeline.
• Reconcile collections received and outstanding receivables against electronic claims submitted and re-submitted.
• Proactively report critical issues to management and submit monthly aging and other reports as required.
• Maintain acceptable turnaround time for obtaining pre-approval of services.
• Design, update and implement policies, procedures and protocols to ensure efficiency and accuracy in insurance operations.
• Monitor insurance rejections and prepare & submit periodic reports to the Head of Finance for review.
• Meet doctors monthly to explain their rejections and provide appropriate guidance to prevent similar rejections in future claims.
• Maintain up-to-date management of central price master with clear comparison of self-pay, ministry approved and various empaneled payor prices.
• Ensure insurance contracts are up-to-date in the system and maintain a proper summary file of key contractual parameters among empaneled insurance companies.
• Supervise billing function at the front desk and coordinate procedural changes to enhance RCM function.
• Monitor billing and pre-authorization activities of outpatient, diagnostics and day surgery.
• Prepare breakdowns for invoices as required by insurance companies or patients for reimbursement processes.
• Educate reception, doctors, nursing and paramedical staff on insurance protocols, new processes or modifications as notified by insurance companies.
• Assist in regular audits conducted by insurance companies and other regulatory agencies.
• Resolve issues and respond to related queries, both internal and external.
• Interact with IT for software development or systems that improve insurance pre-approval and claims process.
• Develop unit budget and ensure departmental operations within budget.
• Communicate with patients regarding insurance policies, eligibility and entitlements.
• Coordinate with colleagues and related departments for smooth RCM operations.

• Minimum 8 to 10 years of experience in a hospital setting in a similar role; payer experience added value.
• Preferred experience in hospitals and/or day care surgical centers.
• Knowledge of insurance approvals, claims and billing process, Qatar laws applicable to insurance legislations, HIS & ERP.
• Experience in revenue cycle management.

• Graduate in Medicine/Life Science or related medical education, and/or Certified Medical Coder (HIMAA/AHIMA).
• Administrative skills: negotiation, problem solving, organizational skills, attention to detail, designing forms, decision making, team player, handling large teams.
• Technical competency: familiar with HIS and RCM process as per regional practice; good typing speed.
• Soft skills:
  
  excellent communication and interpersonal skills.
• Computer skills: MS Office (Word, Excel, PowerPoint, Outlook).
• Language skills: good in written and spoken English;
  Arabic added value.

Immediate joiner preferred, up to QAR 15,000 cash in hand plus two-bedroom apartment.