Head Revenue Cycle Management

Job Summary The Head of Revenue Cycle Management (RCM) is responsible for providing strategic and operational leadership for all revenue cycle functions across the hospital, ensuring optimal revenue capture, reimbursement, cash flow management, and financial sustainability. The role oversees the end-to-end revenue cycle, including patient access, insurance verification, authorization management, medical coding, billing, claims submission, denial management, accounts receivable, collections, and payer relations. The position plays a critical role in driving revenue growth, minimizing revenue leakage, improving operational efficiency, and ensuring compliance with regulatory and payer requirements. Revenue cycle management is identified as a key component of hospital financial performance and operational excellence within healthcare leadership structures Strategic Leadership • Develop and execute the hospital's Revenue Cycle Management strategy aligned with organisational financial objectives. • Drive revenue optimisation initiatives to maximise reimbursements, improve cash flow, and reduce revenue leakage. • Establish departmental goals, KPIs, and performance benchmarks to ensure achievement of financial targets. • Advise executive leadership on revenue cycle trends, risks, opportunities, and performance improvement initiatives. Revenue Cycle Operations • Provide oversight of the complete revenue cycle, including patient registration, insurance verification, pre-authorisation, charge capture, medical coding, billing, claims submission, payment posting, collections, and accounts receivable management. • Ensure efficient and accurate processing of all revenue cycle activities to optimise reimbursement and patient financial experience. • Monitor revenue cycle performance and implement corrective actions to improve operational efficiency. Billing, Claims & Denial Management • Oversee timely submission of claims to insurance providers, TPAs, corporate clients, and self-pay patients. • Lead denial management and appeals processes to minimise claim rejections and maximise collections. • Monitor payer performance and reimbursement trends, identifying opportunities for process improvement. • Ensure compliance with payer contracts, billing guidelines, and reimbursement policies. Accounts Receivable & Cash Flow Management • Direct strategies to improve collections and maintain healthy cash flow. • Monitor AR ageing, outstanding claims, and bad debt exposure. • Develop recovery plans and collection initiatives to achieve collection targets. • Review and approve write-offs, adjustments, and settlement recommendations in accordance with hospital policies. Financial Performance & Reporting • Prepare and present monthly revenue cycle performance reports to the CFO and Executive Leadership Team. • Analyse key financial and operational metrics, including: • Net Collection Rate • AR Days • Denial Rate • Clean Claim Rate • Revenue Leakage • Cash Collections • Gross Revenue and Net Revenue Trends • Provide recommendations to improve profitability and financial performance. Insurance & Payer Relations • Build and maintain effective relationships with insurance companies, TPAs, government payers, and regulatory bodies. • Support contract negotiations and reimbursement discussions with payers. • Ensure timely resolution of payer disputes, audits, recoveries, and reconciliation issues. • Monitor compliance with payer requirements and contractual obligations. Compliance, Audit & Risk Management • Ensure compliance with NHRA regulations, Ministry of Health requirements, payer guidelines, and hospital policies. • Lead internal and external revenue cycle audits. • Implement controls to mitigate financial and operational risks. • Ensure readiness for regulatory inspections and accreditation requirements. Process Improvement & Digital Transformation • Identify opportunities to automate and streamline revenue cycle processes. • Lead the implementation and optimisation of Hospital Information Systems (HIS), EMR, billing, and revenue cycle platforms. • Drive continuous improvement initiatives to enhance productivity, reduce denials, and improve billing accuracy. • Promote a culture of innovation and operational excellence within the department. Leadership & People Management • Lead, mentor, and develop the Revenue Cycle, Billing, Coding, Insurance, and Collections teams. • Establish a high-performance culture focused on accountability, service excellence, and continuous improvement. • Conduct workforce planning, performance management, succession planning, and talent development activities. • Ensure staff receive ongoing training on regulatory updates, payer requirements, and revenue cycle best practices. Stakeholder Collaboration • Partner with Clinical Operations, Medical Staff, Finance, Patient Access, Health Information Management, and Case Management teams to improve revenue capture and operational efficiency. • Work closely with executive leadership on budgeting, forecasting, strategic planning, and business growth initiatives. • Support new service launches, pricing reviews, and revenue enhancement projects across the hospital. Education & Qualifications Essential Bachelor’s Degree in Finance, Accounting, Healthcare Administration, Business Administration, Health Information Management, or a related discipline • Master’s Degree in Business Administration (MBA), Healthcare Administration (MHA), Finance, or a related field is strongly preferred for senior leadership positions. Preferred • Master’s Degree in Healthcare Administration (MHA), Business Administration (MBA), Finance, or a related discipline. • Professional certifications such as: • Certified Revenue Cycle Representative (CRCR) • Certified Professional Biller (CPB) • Certified Professional Coder (CPC) • HFMA Revenue Cycle Certification or equivalent Experience • Minimum 10–15 years of progressive experience in Revenue Cycle Management, Healthcare Finance, Patient Financial Services, Medical Billing, Insurance Operations, or Healthcare Reimbursement within an acute care hospital, rehabilitation facility, or large healthcare organisation. • Minimum 5 years of senior leadership experience managing multi-disciplinary Revenue Cycle functions. Proven track record of improving revenue performance, reducing denials, strengthening collections, and optimising reimbursement processes. Extensive experience in: • Revenue Cycle Operations • Medical Coding and Charge Capture • Insurance Claims Management • Denial Prevention and Appeals Management • Accounts Receivable Management • Revenue Integrity Programmes • Payer Contract Management • Healthcare Financial Analytics and KPI Reporting •

Minimum 10–15 years of progressive experience in Revenue Cycle Management, Healthcare Finance, Patient Financial Services, Medical Billing, Insurance Operations, or Healthcare Reimbursement within an acute care hospital, rehabilitation facility, or large healthcare organisation. Minimum 5 years of senior leadership experience managing multi-disciplinary Revenue Cycle functions. Essential education: Bachelor’s Degree in Finance, Accounting, Healthcare Administration, Business Administration, Health Information Management, or a related discipline. Master’s Degree in Business Administration (MBA), Healthcare Administration (MHA), Finance, or a related field is strongly preferred for senior leadership positions. Preferred certifications include CRCR, CPB, CPC, HFMA Revenue Cycle Certification or equivalent.

Provide strategic and operational leadership for all revenue cycle functions across the hospital, including patient access, insurance verification, authorization management, medical coding, billing, claims submission, denial management, accounts receivable, collections, and payer relations. Develop and execute the Revenue Cycle Management strategy aligned with financial objectives. Drive initiatives to maximise reimbursements, improve cash flow, reduce leakage, and enhance profitability. Establish KPIs and performance benchmarks; report to CFO and Executive Leadership. Oversee billing, claims submission, denial management, AR management, and cash flow strategies. Ensure compliance with payer contracts, guidelines, and regulatory requirements. Lead process improvement and digital transformation of HIS/EMR/billing systems. Mentor and develop Revenue Cycle teams; collaborate with Clinical Operations, Medical Staff, Finance, Patient Access, HIM, and Case Management. Prepare monthly performance reports and provide recommendations for financial improvement. Support contract negotiations, payer relations, and audits; ensure readiness for regulatory inspections and accreditation.