Strategize and establish Price list for all Healthcare services provided in coordination with
Healthcare Operations and Finance both for cash payments and Insurance Payments in compliance with DHA regulations.
Attract Insurance Providers, Third Party Administrators, and Corporates and Government establishment and negotiate for effective business agreement for direct billing with calculated discounts.
Establish and monitor Contract Management with Providers ensuring compliances and credentials.
Develop and establish effective Patient Scheduling and Registration process ensuring Patient satisfaction and Optimization of Healthcare resources.
Establish timely preauthorization monitoring processes for both Outpatient and Inpatients.
Develop protocols, train staff and ensure zero error environments in document verification,
Insurance eligibility and document collection to minimize claim denials.
Establish Claim capture process by effective training and monitoring with proper internal controls.
Develop protocols, train staff and ensure accurate coding, documentation, timely charging and claim submission.
Provide sufficient documents for Finance to raise billing and support the collection process.
Establish effective reconciliation and resubmission analysis with insurance companies.
Supervise all claims and reconciliations to ensure completion of the process in a timely manner.
To ensure effective analysis of the claims and quality assurance audits are performed.
Handle effectively network and price management.
Analyze Financials in terms of revenue cycle management and take effective decisions and implementation.
Ensure all Revenue cycle processes lead to effective Cash Flow Management.
Review Contracts, Price list, Costings, Protocols, Internal Controls, Processes, Unit and Staff performances periodically.
Establish Healthy relationships with providers and inter-depts. and the team with proper communication and regular meetings and follow-ups.
Focus mainly on P / L for all processes.
Hire, Train, Develop, and provide career paths for the team members ensuring the department goal is achieved in line with Business Goals.
Develop and implement strategies to optimize revenue generation, minimize payment delays, and reduce denials. Monitor key performance indicators (KPIs) such as accounts receivable, revenue cycle time, and denial rates.
Develop KPIs on the Unit level, Function level, and Individual level with a reasonable matrix and monitor effectively to ensure high high performance in the environment and deliverables.
Coordinate with other departments to synchronize the revenue cycle functions effectively.
Provide Management Information System (MIS) reports to the Senior Management on a daily, weekly, and monthly basis.
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