Revenue Cycle Manager

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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 the Day Surgery Doctors and other relevant stakeholders on insurance policies and protocols.

Overview

The Revenue Cycle Manager oversees revenue cycle functions, maintains contract relationships with insurance companies, ensures accurate coding, and supports the flow of outpatient and inpatient billing and claims processes.

Responsibilities

• Oversees function of revenue cycle management.
• 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 the profitability of the business.
• Reviews insurance claims to ensure accuracy as per agreement, prior to dispatch to respective insurance companies within stipulated timeline.
• Ensures proper coding - CPT, ICD, HCPCS, DRG codes as applicable.
• Ensure internal audit and review of Outpatient and Inpatient files, billing and claims.
• Keeping a check on pending receivables and ensure payments are received from payors within the contractually agreed timeline.
• Reconcile 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.
• Maintaining 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.
• Meets with Doctors monthly to explain their rejections and provide appropriate guidance to prevent similar rejections in future claims.
• Ensures up-to-date management of central price master with 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 there is a proper summary file which compares the key contractual parameters among the empaneled insurance providers.

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