Revenue Cycle Manager

Job Summary

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