Revenue Cycle Manager

2 weeks ago


Pretoria, Gauteng, South Africa Intercare Group South Africa Full time
Job title : Revenue Cycle Manager (RCM) - Corporate ServicesJob Location : Gauteng, PretoriaDeadline : April 04, 2025Quick Recommended Links
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DUTIES & RESPONSIBILITIES

Revenue Cycle Oversight:

  • Manage the full revenue cycle, including patient registration, charge capture, claims submission, payment posting, and collections.
  • Ensure accurate and timely billing to medical aid schemes, patients, and third-party payers.

Claims Management:

  • Oversee submission and follow-up of claims to medical aid schemes (e.g., Discovery, GEMS) and government bodies, minimising rejections and resubmitting rejected claims efficiently.
  • Monitor and improve claim approval rates and revenue recovery timelines.

Financial Performance:

  • Optimise cash flow by reducing days in accounts receivable and addressing revenue leakage (e.g., unbilled services, uncollected co-payments).
  • Prepare and analyse revenue cycle reports, providing insights to senior management on KPIs such as debtor days, collection rates, and bad debt ratios.

Compliance and Coding:

  • Ensure adherence to South African healthcare regulations (e.g., Council for Medical Schemes guidelines, National Health Act) and readiness for National Health Insurance (NHI) developments.
  • Supervise accurate use of billing codes (e.g., ICD-10, procedural tariffs) to support compliant and successful claims.

Team Leadership:

  • Lead, train, and motivate the RCM team, fostering a culture of accuracy, efficiency, and patient sensitivity.
  • Develop staff skills in medical billing, coding, and customer service.

Process Improvement:

  • Implement and maintain RCM systems (GoodX, SharePoint, PowerBI) to streamline workflows and enhance automation.
  • Identify and address inefficiencies in the revenue cycle, collaborating with clinical and administrative teams to improve payment allocation, payment methods, patient communication, and registration processes.

Stakeholder Collaboration:

  • Work closely with patient administration, clinical staff, and IT teams to ensure seamless revenue cycle operations.
  • Liaise with medical aid schemes and external partners to resolve payment disputes and improve reimbursement processes.

Patient Experience:

  • Oversee patient billing communications, ensuring clarity and sensitivity, particularly for underserved or uninsured patients.
  • Address patient queries related to billing or medical aid shortfalls in a professional and empathetic manner.

REQUIREMENTS

Education:

  • Bachelor's degree in Finance, Accounting, Healthcare Management, or a related field.
  • Additional certification in medical billing/coding (e.g., ICD-10 certification) or revenue cycle management is highly advantageous.

Experience:

  • Minimum of 5 years' experience in revenue cycle management, billing, or financial management within a healthcare setting.
  • At least 2 years in a supervisory or managerial role.
  • Proven track record of managing claims with South African medical aid schemes and improving revenue outcomes.

Technical Skills:

  • Proficiency in RCM or financial software (e.g., GoodX, Sage) and Microsoft Office (especially Excel).
  • Strong understanding of South African healthcare billing codes (ICD-10) and medical aid processes.

Knowledge:

  • In-depth knowledge of South African healthcare regulations (e.g., CMS, NHI framework) and financial reporting standards (e.g., IFRS).
  • Familiarity with socio-economic challenges affecting patient payments in South Africa.
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