Revenue Cycle Manager

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 liaison 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 insurance rejections, managing insurance contracts and benefits, overseeing insurance operations, and designing, implementing, and training AMNM Day Surgery Doctors and other stakeholders on insurance policies and protocols.

Responsibilities

• Oversees function of revenue cycle management of AMNM.
• Manages and negotiates contracts with insurance companies to obtain recognition as a service provider.
• Liaises with insurance companies regarding eligibility, payments reconciliations, service additions to maximize profitability.
• Reviews insurance claims to ensure accuracy as per agreement prior to dispatch to insurers within stipulated timeline.
• Ensures proper coding – CPT, ICD, HCPCS, DRG codes as applicable.
• Ensures internal audit and review of outpatient and inpatient files, billing and claims.
• Keeps check on pending receivables and ensures payments are received from payors within contractually agreed timeline.
• Reconciles all collections received and outstanding receivables against all electronic claims submitted and re‑submitted.
• Proactively reports critical issues to Management and submits monthly aging and other reports to Management as required.
• Maintains acceptable turnaround time for obtaining pre‑approval of services.
• Designs, updates and implements policies, procedures and protocols to ensure efficiency and accuracy in insurance operations.
• Monitors insurance rejections and prepares & submits periodic reports to the Head of Finance for review.
• Meeting doctors monthly to explain their rejections and providing appropriate guidance to prevent similar rejections in future claims.
• Ensures up‑to‑date management of central price master which has a clear comparison of self‑pay, ministry approved and various empaneled payor prices.
• Ensures that the insurance contracts are up to date on the system and that there is a proper summary file which compares key contractual parameters among the empaneled insurance companies.
• Supervises billing function at the front desk, measuring effectiveness and efficiency of ongoing front desk‑related procedures and coordinates procedural changes if required to enhance the RCM function.
• Monitors the billing and pre‑authorization activities of outpatient diagnostics and day surgery.
• Prepares breakdowns for the invoices as required by insurance companies or patients for reimbursement process.
• Educates reception, doctors, nursing and paramedical staff on insurance protocols, new processes or modifications as notified by insurance companies from time to time.
• Assists in the regular audit conducted by the insurance companies and other regulatory agencies.
• Resolves issues and responds to any related queries both internal (other departments) and external (regulatory agencies, insurance companies).
• Interacts with IT for any software development or applicable systems that help improve the insurance pre‑approval and claims process.
• Develops the unit budget and ensures departmental operations are effectively conducted within the budget.
• Communicates with patients regarding their insurance policies, eligibility and entitlements.
• Coordinates with colleagues and other related departments for smooth running of RCM operations.

Experience Required

Preferred Experience

Skills Required

Licensing / Certifications

Core Competencies

Technical

Soft Skills

Computer Skills

Language Skills

Employment Type

Full Time

Vacancy

Benefits

Up to 15k QAR cash in hand plus two‑bedroom apartment.

Other

Any nationality. Immediate joiner is preferred but not a must.

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