RCM Manager

<div><p>The RCM Manager is responsible for overseeing the end-to-end revenue cycle process, including insurance verification, pre-authorizations, claims submission, follow-ups, and collections. The role ensures accurate billing, timely reimbursements, and compliance with payer and regulatory requirements, ultimately optimizing the organization’s revenue and cash flow.</p><p>Key Responsibilities and expectations include accurate billing, timely reimbursements, and adherence to payer and regulatory requirements, optimizing revenue and cash flow.</p><h3>Key Responsibilities</h3><h3>1. Claims Management</h3><ul><li>Oversee accurate and timely submission of insurance claims</li><li>Ensure compliance with payer requirements and coding standards</li><li>Monitor claim rejections and denials, and implement corrective actions</li></ul><h3>2. Insurance&Approvals</h3><ul><li>Manage pre‑authorization and approval processes with insurance providers</li><li>Ensure eligibility checks and coverage validation prior to services</li><li>Liaise with insurers to resolve approval‑related issues</li></ul><h3>3. Denials&Collections Management</h3><ul><li>Analyze denial trends and implement strategies to reduce rejection rates</li><li>Oversee resubmissions and appeals for denied claims</li><li>Ensure timely collections and follow‑up on outstanding receivables</li></ul><h3>4. Revenue Optimization</h3><ul><li>Identify revenue leakage and implement corrective measures</li><li>Improve billing accuracy and turnaround times</li></ul><h3>5. Team Management</h3><ul><li>Lead and manage the RCM team including billing, coding, and collections staff</li><li>Provide training and continuous development for team members</li><li>Set performance targets and monitor team productivity</li></ul><h3>6. Systems&Compliance</h3><ul><li>Ensure effective use of HIS, billing systems, and insurance platforms (e.g., NPHIES)</li><li>Maintain compliance with local regulations and insurance guidelines</li><li>Coordinate with clinical and finance teams for accurate documentation</li></ul></div>#J-18808-Ljbffr