Revenue Cycle Operations

Job Description

To lead and oversee the RCM operations, partner providers, processes of audit and compliance, execute special RCM projects and participate in different analytical activities ensuring the effectiveness and proper execution of the clinical revenue cycle.

Revenue Cycle Operation

• Develop and maintain a strategic approach to the revenue cycle that aligns with the broader objectives of Bupa insurance.

• Oversee the collaboration with clinical and administrative departments to ensure a seamless integration between care delivery and insurance processing systems.

• Claims Management: Oversee the claims process to insurance providers, ensuring accuracy and compliance with insurance policies.

• Ensure that all claims, denials, and appeals are efficiently processed, and for resolving billing related issues.

• Lead revenue optimization initiatives for cost management.

• lead metrics and reporting to monitor and improve revenue operations effectiveness.

• Drive smooth integration between clinical services and billing systems.

Partner providers mangment

• Conduct comprehensive market analysis to identify potential partner providers.

• Negotiate favourable terms in contracts with partner providers.

• Establish and maintain robust relationships with partner providers’ RCM departments.

• Building strategies to ensure continuous improvement in partner performance.

• Ensure having a comprehensive database of partner providers.

• Organize regular meetings and workshops with partner providers.

• Create and monitor KPIs for partner provider performance.

• Work closely with the legal team to ensure compliance in partner contracts.

Audit and compliance

• Develop and maintain a compliance risk management plan.

• Monitor audit findings with stakeholders and implement corrective actions

• Review and update compliance policies and procedures regularly

• Monitor industry changes and adjust compliance strategies accordingly.

Skills

§ Analytical skills

§ Project management skills

§ Communication skills

Education

medicine, Pharmacy, or related healthcare field