The Revenue Cycle Manager is responsible for processing finance that healthcare facilities use to track patient care episodes from registration and appointment, scheduling to the final payment of balance. Communicating with health insurance, when a patient schedules an appointment the physician office or hospital staff typically checks the patient insurance coverage prior to visit.
The RCM unifies the business and clinical sides of healthcare by coupling administrative data such as a patient’s name, insurance provider and other personal information and the treatment a patient receives.
- To establish and maintain business relationship
with insurance companies and corporate clients with a combination of comfort
and profitability, involved in the planning and negotiation of tariffs, smooth
implementation and handling of new insurance policies after agreement is
signed, and management of all related operational issues with a primary focus
on growth and profit maximisation.
- Handling overall insurance management activities
across diverse classes and portfolios, envisaging strategic plans and devising
strategies for implementation.
- Resolving complex situations using high service
oriented handling methodology, liaising with clients and decision makers on critical
- Directing the implementation of an effective,
consistent service structure and overseeing administration of policies and
procedures to augment day-to-day operations.
- Comparison of Tariffs for discount negotiation
with contracted insurance companies.
- To design and implement a protocol for insurance
practices in the hospital.
- Managing the screening process of raised
insurance invoices and inform concerned department on the discrepancies for
quick rectification of the same.
- Procuring & handling, claims/e-claims
submission processes and ensure timely submission and Re-submission of all
invoices as per the agreed submission date with all Insurance and corporate
- Monitor Insurance claims
rejection percentage and take measures-develop guidelines and suggestions to
control the same.
- Responsible for
providing reports of rejection rates of insurance claims to the Management
based on the complication of the reconciliation records.
- Responsible for complete
analysis of the rejection reports in order to specify and intimate the
management on the major as well as minor causes of rejection rates.
- Work closely with
Management as well as other subsidiary departments in rectification of the
causes so as to decrease the rejection percentage.
- Handling customer
queries and grievances regarding their insurance policies and other complaints.
- Developing and deploying
a training program on new and old insurance policies from time to time for the
hospital front office and back office staff keeping them updated with the
Insurance policies to ensure smooth operations.
negotiations and discussions of rejected claims with the various contracted
- Monitors aged accounts
and verifies appropriate collections procedures are being followed, monitor
receipt allocation in the system as per payment details provided by the
- Ensure customers pay
within their agreed payment terms, chasing payments.
- Conduct regular meetings
with customers to build a strong relation with management and finance team
- Enforce credit policy
and assure adherence to accepted standards
- Follow up on the credit
notes/debit when issues are resolved with the customers
- Perform DSO calculation
- Ensure monthly statements
are prepared and send to customers
- Regularly meet with the
finance director to give update on receivables and rejection.
- Post and reconcile all
receivable account on System.
- Perform bank
reconciliation and ensure all transactions are posted on system.
- Liaise with Company’s
internal and external auditors for the periodic audits.
- Ensures an equitable
distribution of work assignments between subordinates, and gives useful timely
feedback to subordinates on work performance.
- Ensure hospital compliance
with DHA regulatory regarding any insurance related issues.
- Performing any other
job-related task assigned by direct manager.
Continuum of Care
sufficient numbers of qualified and competent persons are available to provide
assessment and improvement of the quality of services provided in the
self, department and team at large on enhancing patient care and experience.
updates and maintains compliance with all JCI policies, procedures and best
quality assessment and quality improvement activities in response to
opportunities and threats.
accurate and effective handling of all information.
knowledge to good effect in different situations and scenarios.
Safe Practice and Environment:
the principles of standard precaution in accordance with current safety
Code of Conduct:
to dress code, appearance neat and clean.
and ensure patient confidentially at all times.
to work on time and as scheduled.
Employee ID/DHA license while on duty.