Revenue Cycle Manager

Position Summary

Revenue Cycle Manager with following requirements

• Should have worked under Hospital environment preferably in UAE.
• Must have 8+ years of Experience relevant to the position
• Should have success record in management of personnel & their KPI evaluations, process, driving to improvements in controls and avoidance of revenue billing.
• Strong inter-personal skills to deal with Clinical and Para-medical staff in streamlining of process.
• Skills for training, clarifying, public speaking and reporting to Senior Management.
• Networking and Development, Relationship management with all insurers and payers.
• Computer skills to analyze and interpret the data and to offer suggestion to Management.
• Arabic Speaking knowledge would be + factor for all patient interactions.

Summary of Main Duties

•    Creates and modifies in consultation with Director of Finance & Admin, a work-flow which meets the expectations of the Insurance requirements, as well as meets the control aspects of the Hospital Finance departments. Strive to improve upon the work-flow from time to time as the situations demand.
•    Obtains and frequently compares the pricing for services of the Hospital with the competitors’ pricing of similar services and plans for price corrections, changes.   Develop a Pricing strategy and finalizes it through further discussions among functional Director of Finance & Admin,  and  Marketing Manager.
•    Establish a periodic training and interaction with the Medical team to clarify and validate the medical issues of the claim and ensure that the rejections are explained and avoided for each and every clinical and surgical doctors.   
•    Validate the reports of doctors compensation (both Employed and  Visiting doctors), and timely completion of the validation so that the payments will be completed on time.
•    Identifies the areas of improvement of CPT billing skills and interacts with Hospital clinicians to enhance the areas of billing services to ensure that no services would go unbilled.  Constantly revise the coding structure in line with the accepted standards of business practice in the region.    Frequently addresses the guidance to the clinicians on CPT billing mechanism through the departmental trainings and skill development meetings.
•    Develop the ICD 10CM coding and mapping of services to CPT.   Ensure that the risk of loss of revenue is minimized with correct mapping and the medical necessity is justified.
•    Ensures that adequate margins are built up on Consumables to ensure recovery of direct and indirect cost of Purchasing, Procurement, Storing, Warehousing and Financing cost of purchases. Develop an acceptable coding structure at the hospital for billing such Consumables.
•    Frequently meet and improve the Revenue Cycle functions in the IT system and provide inputs for improvement.  The submissions portion of IT system (E claims) need to be periodically analyze for claim settlements, resubmissions etc.  The reconciliation of revenue as per H.I.S system and Claim system to be constantly ensured to avoid any billed amounts being missed to be submitted as claims.  Furthermore to ensure that delays are  avoided and deadlines are maintained both for submission of claims and resubmissions

.•    Ability to create reports independently and analyze them to suggest improvements.  Ability to create and analyze the outstanding from various payers and periodically review the collections and follow up on the uncollected cases.  Attend to the payer’s offices – call them – interact for better collection management.

•    Must clearly understand coding and to establish the most efficient and effective system of coding and to train healthcare professionals on how to use coding and ensure maximum revenue capture.

Responsibilities

•    Identifies the areas of improvements in faster submission of invoices to reduce the turn-around-time of payment of each invoice. Avoid delay in submission and loss of revenue by reviewing frequently the status of submissions.
•    Identifies and maximizes the re-submission of invoices to reduce the % of rejections from the insurance claims as well as sponsored patients.  Frequently facilitates the claim reconciliation meetings with various insurance companies.
•    Interacts with the Supply chain management to ensure that all billable supplies used to patients are charged and are adequately priced and the non-chargeable items are restricted to absolute minimum.
•    Brings about synergy among the front-office functions and back-office billing.
•    Ensures that the proper system of  claims to Insurance companies are pre-screened to avoid any possible rejections and delay in settlements for requirement of supporting documentation.
•    Constantly in contact with Insurance companies and other Payers to reduce the payment period to as much as possible.
•    Ensures that the claims are pre-checked and submitted with minimum amount of possible errors which leads to payment of claims with minimum rejections.
•    Provides inputs to Senior Management about the possibilities of establishing new accounts and interacts with the Marketing Manager for this purpose.     Would provide inputs to Senior Management in review of new Contracts and Renewal contracts with various Payers.
•    Ensure strong Man-power management and should have inter-personal skills in handling the issues.  Holding of team together and ensure that optimum utilization of resources are ensure. 
•    Provides consultative and recommendation clarifications of dealing with Patient billing issues, interact and resolve the issues relating to patient complaints, billing issues and other similar tasks as and when referred by the front-office staff.   Also required will be analytical skills to suggest and provide the discount structure of the invoices (such as if we give 5% discount extra how much will be amount or , alternative how much will be discount % if we reduce the invoice by “X” amount.
•    Meets the patients and their representatives to clarify any Financial Issues on billing, refunds, pricing or settlement of invoice issues and provides a workable alternative within the framework of the Hospital policy and its permitted variances.
•    Prepare, validate and submit reports to authorities such a Sharjah Health Authority for Billing of Sharjah Social Welfare 
•    Prepare, validate and submit reports to Sharjah Finance Department from time to time.
•    Prepare, validate and submit reports to the Auditors (including Statutory auditors, Govt Auditors, Internal Auditor etc) from time to time.
•    Such other functions desired from the functional Director from time to time as may be required

Position Requirements/Qualifications

Position 
Requirements/Qualifications

•    Graduate with additional Qualfication of any relation to Job.
•    6-8 years in similar environment and as Manager

Skills expected    :

Extensive Excel skills and Computer skills to discharge job functions

Position criteria Other Skills/Abilities