Revenue Cycle Manager

Job Title: Revenue Cycle Manager

Reporting To: Head of Finance

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

Responsibilities Oversees function of revenue cycle management of AMNM.

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.

Supervises billing function at the Front Desk (-