Manage the entire revenue cycle: registration, eligibility, coding, charge capture, billing, claims submission, denial management, collections, and reporting.
- Ensure accurate data flow from clinical departments (radiology, labs, radiotherapy, clinics).
- Lead the implementation and optimization of RCM workflows within HIS/RIS/LIS systems.
B. Insurance & Payer Management
- Maintain strong relations with insurers (cooperative health insurance companies, TPAs).
- Ensure compliance with CCHI, NHIC, and MOH regulatory requirements.
- Monitor payer contract performance, reimbursement trends, and tariff updates.
- Manage pre-authorization workflows for radiology, lab, and radiotherapy services.
C. Coding & Compliance
- Ensure correct application of ICD-10, CPT, HCPCS, and local coding standards.
- Work with clinical teams to ensure proper documentation for high-cost treatments such as radiotherapy.
- Conduct regular audits to ensure coding and billing accuracy.
D. Claims & Denial Management
- Oversee timely submission of electronic and manual claims to payers.
- Analyze reasons for rejections/denials and implement corrective actions.
- Reduce AR days, improve collection rates, and minimize write-offs.
- Ensure reconciliation of submitted claims, remittances, and payments.
E. Patient Billing & Cash Management
- Oversee self-pay billing, discounts, co-pay collections, and financial counseling.
- Ensure transparent pricing for imaging, labs, and home services.
- Manage POS collections at clinics and home-service teams.
F. Reporting & Performance Monitoring
- Develop weekly and monthly RCM KPIs, including:
- AR aging
- Clean claim rate
- Denial rate & root causes
- Days in AR
- Collection rate
- Provide analytical insights to management to improve revenue performance.
- Forecast revenues and support budgeting processes.
G. Team Leadership
- Manage and train staff in registration, billing, coding, approvals, and collections.
- Implement performance review systems and continuous improvement programs.
- Collaborate closely with radiology, lab, oncology, home services, and finance teams.
About The Role
The RCM Manager oversees the full revenue cycle from patient registration to final payment collection, ensuring accurate billing, compliance with KSA healthcare payer rules, efficient claims management, and optimized cash flow. The role supports clinical departments including radiology, laboratory, radiotherapy, outpatient clinics, and home healthcare.
