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Insurance & Revenue Cycle Management (RCM) Director
National Blood & Cancer Center - NBCC
Riyadh, KSA
Full Time
Director
Onsite
1 months ago
Revenue Cycle ManagementContract NegotiationFinancial AnalysisClaims ManagementMedical Coding (ICD 10 AM)Hospital Information Systems
Free
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Revenue Cycle ManagementContract NegotiationFinancial Analysis
About the Role
The National Blood & Cancer Center seeks an Insurance & RCM Director to lead strategic management of insurance relationships, contracts, and revenue cycle operations. The role oversees medical approvals, claims, rejection analysis, and network expansion to maximize revenue and achieve annual growth targets.
Key Skills for This Role
Revenue Cycle ManagementContract NegotiationFinancial AnalysisClaims ManagementMedical Coding (ICD 10 AM)Hospital Information Systems
Responsibilities
- Review and evaluate current insurance policies to protect financial interests and secure optimal reimbursement rates
- Identify, negotiate, and establish new contracts with medical insurance companies and TPAs
- Oversee end to end workflow of medical approval requests and ensure timely submission of financial claims
- Analyze root causes of medical and technical rejections and implement corrective action plans
- Follow up on collections, settlements, and aging accounts receivable with insurance companies
- Analyze revenue share and financial performance of each insurance provider
- Develop and execute strategic pricing and negotiation tactics for annual revenue growth
- Coordinate with clinical and ancillary departments to improve medical documentation and data quality
- Prepare and present comprehensive performance reports to executive management
Requirements
- Bachelor's degree in Medicine & Surgery, Pharmacy, Healthcare Management, or related field
- Minimum 5 7 years of progressive experience in medical insurance management within a major hospital or specialized medical center
- Proven track record of negotiating high value medical contracts
- Advanced capability in financial data analysis using KPIs
- Deep understanding of local health insurance laws and regulations (e.g., CHI rules)
- Full professional proficiency in Arabic and English
- Advanced proficiency in Hospital Information Systems and data analysis tools
- Master's degree (MBA/MHA) or professional certification in health insurance/RCM is highly preferred
Full Job Posting
Job Summary
- The Insurance & RCM Director is responsible for the strategic and operational management of all relationships, contracts, and agreements with medical insurance companies. This role aims to maximize revenue, expand the center’s payer network, and optimize the Revenue Cycle Management (RCM) process.
Key Responsibilities
- Contract Management & Strategic Partnerships: Policy Review & Optimization, Network Expansion, Relationship Management
- Operational Management (Claims & Approvals): Approvals & Claims Supervision, Rejection Management, Financial Reconciliation
- Financial Analysis & Revenue Growth: Revenue & Profitability Analysis, Annual Growth Targets, RCM Cross Functional Collaboration
- Reporting: Periodic Reporting to executive management
Job Requirements & Qualifications
- Bachelor’s degree in Medicine & Surgery, Pharmacy, Healthcare Management, or related field. Master’s degree (MBA/MHA) or professional certification in health insurance/RCM is highly preferred.
- Minimum of 5 to 7 years of progressive experience in medical insurance management within a major hospital or specialized medical center.
- Proven track record of negotiating high value medical contracts.
- Advanced capability in financial data analysis, utilizing KPIs.
- Deep understanding of local health insurance laws, regulations (e.g., CHI rules), and medical coding standards (ICD 10 AM).
- Strong leadership, communication, and interpersonal skills.
- Full professional proficiency in both Arabic and English.
- Advanced proficiency in Hospital Information Systems (HIS) and data analysis tools (e.g., MS Excel or BI tools).
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