Revenue Cycle Manager
2 weeks ago
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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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