Description

Job Description

The Billing Analytics & Reconciliation Specialist (Group Level) is responsible for ensuring the completeness, accuracy, and timeliness of billing, reconciliation, and revenue reporting across all hospital units within the group. The role focuses on identifying revenue leakages, validating charge capture, reconciling financial and operational data, managing outstanding balances, coordinating with legal teams for escalated cases, and maintaining key performance indicators (KPIs). This position plays a critical role in strengthening revenue cycle integrity, preventing financial leakage, and supporting timely collections across all group locations.

Responsibilities

Key Responsibilities: 

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1. Billing Accuracy & Charge Validation

• Ensures all services, procedures, investigations, and consumables are billed correctly across all hospital locations.
• Reviews transactions to detect missing charges, incorrect allocations, and mismatches between Cerner, RHES, and other systems.
• Identifies clinical orders completed but not billed and coordinates with clinical and IT teams to resolve them.
• Ensures charge‑capture processes are complete, accurate, and aligned with policy and workflow standards.

2. Group‑Level Reconciliation

• Performs periodic reconciliation across all hospitals to ensure billing and financial accuracy.
• Reviews discounts for unauthorized or excessive entries.
• Resolves unclear patient deposits and ensures correct allocation before discharge or billing.
• Validates refunds through documentation and approval checks.
• Reconciles clinical orders against billed items to identify missed charges.
• Reviews self‑pay outstanding balances and escalates long‑pending cases.

3. Outstanding Balance Monitoring & Legal Coordination

• Monitors receivables including self‑pay and insurance accounts.
• Works with Legal on escalated cases, preparing case summaries and documentation and tracking progress to closure.
• Follows up with departments to ensure timely settlement of dues.

4. MIS, Analytics & Reporting

• Prepares group‑wide billing dashboards and financial performance reports.
• Generates utilization, AR ageing, and variance analysis reports.
• Develops revenue‑leakage reports and performs data analysis to identify trends and discrepancies.
• Provides insights and recommendations to RCM leadership and senior management.

5. Revenue Integrity & Process Improvement

• Identifies revenue‑leakage risks and implements preventive controls.
• Conducts periodic audits on billing, charge capture, refunds, approvals, and reconciliation.
• Ensures compliance with billing policies, payer requirements, and internal controls.
• Supports process improvement efforts to enhance accuracy, efficiency, and turnaround time.

6. Cross‑Functional Collaboration

• Works closely with Billing, RCM, Finance, Legal, Clinical teams, and IT.
• Supports departments in improving documentation and charge‑capture practices.
• Provides staff training on billing workflows and system functionality.
• Participates in HIS enhancements and system‑integration projects.

7. JCIA‑Aligned Safety, Quality & Professional Standards

• Supports sustainability and environmentally responsible practices.
• Adheres to patient safety, infection control, risk management, and incident reporting procedures (e.g., SBAR).
• Participates in mandatory emergency drills and maintains required competencies and credentials.
• Ensures accurate documentation, maintains data confidentiality, and follows safe medication practices.
• Reports safety hazards, protects information systems, follows cybersecurity protocols, and maintains ethical, professional conduct.
• Participates in audits, quality‑improvement initiatives, and complies with all JCIA‑related standards.

8. Other Responsibilities

• Performs additional duties assigned by leadership to meet operational needs.
• Complies fully with organizational policies, procedures, legal requirements, and updates.
• Avoids and reports any actions that may cause financial loss or reputational damage, including fraud or misrepresentation.
• Maintains strict confidentiality of patient, staff, and organizational information.

Qualifications

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Education

• Bachelor’s degree in Finance or Accounting.

Experience

• 3–5 years of experience in hospital billing, reconciliation, MIS, revenue integrity, or Revenue Cycle Management (RCM).

Training, Knowledge & Skills

• Strong proficiency in Microsoft Excel and other Microsoft Office applications for data analysis, reporting, and documentation.
• Experience using Business Intelligence tools (e.g., Power BI) for dashboard creation and analytics.
• Working knowledge of Hospital Information Systems (HIS), including Cerner and Oracle.
• Solid understanding of hospital billing workflows, RCM processes, and charge‑capture practices for procedures, labs, diagnostics, and consumables.
• Ability to perform financial reconciliation, identify discrepancies, and detect revenue leakage.
• Familiarity with medical terminology and basic medical coding concepts.
• Awareness of KCH policies and related initiatives.
• Capable of supporting and guiding junior team members.
• Strong confidentiality and discretion in handling sensitive information.
• Excellent verbal and written communication skills for effective collaboration across teams and stakeholders.
• Highly motivated, goal‑driven, adaptable, and able to manage changing priorities.
• Strong problem‑solving skills with the ability to handle unexpected issues and escalate when necessary.
• Demonstrates professionalism, credibility, and the ability to multitask efficiently in a fast‑paced environment.