Description

Job Description

Job Purpose

The RCM Manager is responsible for overseeing the end-to-end revenue cycle process, including insurance verification, pre-authorizations, claims submission, follow-ups, and collections. The role ensures accurate billing, timely reimbursements, and compliance with payer and regulatory requirements, ultimately optimizing the organization’s revenue and cash flow.

Key Responsibilities

1. Claims Management

• Oversee accurate and timely submission of insurance claims
• Ensure compliance with payer requirements and coding standards
• Monitor claim rejections and denials, and implement corrective actions

2. Insurance & Approvals

• Manage pre-authorization and approval processes with insurance providers
• Ensure eligibility checks and coverage validation prior to services
• Liaise with insurers to resolve approval-related issues

3. Denials & Collections Management

• Analyze denial trends and implement strategies to reduce rejection rates
• Oversee resubmissions and appeals for denied claims
• Ensure timely collections and follow-up on outstanding receivables

4. Revenue Optimization

• Identify revenue leakage and implement corrective measures
• Improve billing accuracy and turnaround times

5. Team Management

• Lead and manage the RCM team including billing, coding, and collections staff
• Provide training and continuous development for team members
• Set performance targets and monitor team productivity

6. Systems & Compliance

• Ensure effective use of HIS, billing systems, and insurance platforms (e.g., NPHIES)
• Maintain compliance with local regulations and insurance guidelines
• Coordinate with clinical and finance teams for accurate documentation