Description

Job Description

Job Summary

The Revenue Cycle Management (RCM) Manager is responsible for supervising and coordinating end-to-end revenue cycle operations across assigned healthcare facilities. The role ensures accurate claim submissions, effective rejection and denial management, optimized Accounts Receivable (AR) performance, and compliance with local and national insurance regulations. The RCM Manager works closely with clinical teams, front office staff, and finance to support revenue integrity and improve overall cash flow.

Key Responsibilities

Revenue Cycle Operations

• Oversee the full RCM lifecycle including eligibility verification, pre-authorizations, coding validation, billing, claim submission, payment posting, and collections
• Ensure accurate and timely claim submission in line with payer filing deadlines
• Monitor charge capture processes to prevent revenue leakage
• Validate tariff mapping in accordance with payer contracts
• Coordinate reconciliation between EMR, billing, and finance systems

Rejection & Denial Management

• Monitor daily and monthly claim rejection rates
• Classify rejections into administrative and clinical categories
• Identify recurring issues and escalate complex cases as needed
• Ensure timely correction and resubmission of rejected claims
• Maintain rejection tracking dashboards and support root cause analysis initiatives

Accounts Receivable (AR) Management

• Monitor Insurance AR and Patient AR
• Follow up on aged and high‑value outstanding claims
• Escalate delayed payments to payers when required
• Support recovery of underpayments

Clinical Documentation & Coding Support

• Coordinate with physicians to ensure accurate ICD‑10 and CPT coding
• Review documentation to minimize clinical denials
• Identify documentation gaps and recommend improvements
• Support periodic documentation and coding audits

Reporting & Performance Monitoring

• Prepare regular RCM performance reports including revenue performance, rejection trends (payer-wise and physician-wise), AR aging, collection ratios, and underpayment tracking
• Provide insights and recommendations to improve financial performance

Compliance & Quality Assurance

• Ensure adherence to local and national healthcare regulations and insurance guidelines
• Maintain proper documentation for audits and compliance reviews
• Ensure accurate and compliant billing practices

Team Supervision

• Supervise insurance coordinators and billing staff
• Allocate tasks, monitor daily productivity, and ensure performance accountability
• Provide guidance, training, and ongoing support to the team

Qualifications & Experience

• Bachelor’s degree in Healthcare Management, Finance, Accounting, or a related field
• 3–5+ years of experience in Healthcare Revenue Cycle Management
• Previous supervisory or team leadership experience preferred
• Strong understanding of insurance frameworks, claims cycles, and regulatory requirements (country-specific)
• Knowledge of ICD‑10 and CPT coding
• Experience in a multi‑specialty or ophthalmology healthcare environment is an advantage

Skills & Competencies

• Strong analytical and problem‑solving skills
• High attention to detail and accuracy
• Effective communication and coordination skills
• Ability to manage deadlines and follow‑up effectively

Requirements added by the job poster

• 1+ years of work experience with RCM