Revenue Cycle Manager

3 days ago

Doha, Baladīyat ad Dawḩah, Qatar RIG (Recruitment International Group) Full time

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

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.


• Meeting Doctors monthly to explain their rejections and providing appropriate guidance to

prevent similar rejections in future claims


• Ensure 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 there is a proper

summary file which compares the key contractual parameters among the empaneled insurance

companies.

Experience and Skills Required

Experience required:


• Minimum - 8 to 10 years of experience in a hospital setting in a similar role (Payer-

Experience will be added value).

Preferred Experience:


• In Hospitals and/or Day care surgical centers

Skills required:


• Knowledge on insurance approvals, claims and billing process.


• Knowledge on Qatar laws applicable to insurance legislations.


• Knowledge on HIS & ERP. -


• Experience in revenue cycle management.

Qualification's Essential:


• Graduate in Medicine /Life Science or other related medical education, and/or


• Certified Medical Coder (HIMAA/ AHIMA).

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