Revenue Management Specialist - RCM

Position Overview

We are seeking a highly motivated and detail-oriented Revenue Management Specialist - RCM to join our Finance & Revenue Cycle Management team. In this pivotal role, you will play a critical part in overseeing and optimizing financial operations, insurance claim processes, and revenue cycle activities within our healthcare environment. Your expertise will be instrumental in ensuring the accuracy, timeliness, and transparency of financial transactions, including invoices, payments, collections, and insurance claims, while fostering strong relationships with healthcare providers, insurers, and internal stakeholders.

Key Responsibilities

The Revenue Management Specialist - RCM will be responsible for a comprehensive range of financial and operational duties, including:

• Financial Oversight and Validation:
  • Review and validate all invoices submitted by service providers to ensure accuracy, completeness, and adherence to contractual terms.
  • Validate quotations for services and confirm alignment with approved contractual agreements.
  • Collaborate with Finance and leadership teams to monitor budget adherence, forecasting, and expenditure control.
  • Lead the preparation, monitoring, and management of annual budgets in alignment with organizational strategic and operational objectives.
  • Prepare monthly financial analysis and variance reports, providing actionable recommendations for corrective measures.
  • Ensure timely submission and processing of work completion certificates, invoices, and related financial documentation.
  • Provide regular updates on operational financial status, including CAPEX, OPEX, contractor payments, insurance payments, governance-related expenditures, and accreditation-related costs.
  • Monitor CAPEX and OPEX allocation to ensure projects and procurement activities are executed within approved budgets and timelines.
• Insurance and Revenue Cycle Management:
  • Oversee the monthly insurance claim submission process across multiple insurance providers.
  • Validate claim accuracy, completeness, and compliance with insurer requirements to minimize rejections.
  • Monitor claim rejection rates and implement corrective action plans to enhance reimbursement timelines and reduce denials.
  • Lead reconciliation meetings with insurers and service providers to resolve payment discrepancies and ensure transparency.
  • Ensure timely collection and reconciliation of incurred and accrued claims revenue.
• Reporting and Strategic Analysis:
  • Prepare and present financial and insurance performance reports to senior management, highlighting key trends and insights.
  • Track and monitor KPIs related to finance, revenue cycle management, and collections to drive operational efficiency.
  • Identify risks, inefficiencies, and opportunities for revenue optimization and cost control through data-driven analysis.
  • Support decision-making processes with financial modeling, forecasting, and strategic recommendations.
• Leadership and Stakeholder Management:
  • Serve as the primary point of contact for financial and insurance-related matters with insurers, service providers, and internal stakeholders.
  • Collaborate with healthcare operations, finance, and leadership teams to align financial and operational objectives.
  • Facilitate cross-functional collaboration to improve financial performance and revenue cycle efficiency.
  • Support internal and external audits, ensuring compliance with financial policies, procedures, and regulatory requirements.
• Additional Responsibilities:
  • Provide support for administrative activities related to finance and revenue cycle management as required.
  • Perform any other duties assigned by management to contribute to the overall success of the organization.

Qualifications and Experience

To excel in this role, candidates must meet the following requirements:

• Education:
  • Bachelor's Degree in Finance, Accounting, or a related field (required).
  • Master's Degree in Finance, Accounting, Business Administration, or a related discipline (preferred).
• Professional Certifications: One or more of the following certifications is preferred:
  • CPA (Certified Public Accountant)
  • CMA (Certified Management Accountant)
  • ACCA
  • CIMA
• Experience:
  • Minimum of 6 years of relevant experience in finance, accounting, or revenue cycle management.
  • At least 3 years in a lead or supervisory role, demonstrating the ability to manage complex financial processes and teams.
• Skills and Competencies:
  • Strong analytical and problem-solving skills with a keen attention to detail.
  • Excellent communication and interpersonal abilities to liaise with stakeholders at all levels.
  • Proficiency in financial software, ERP systems, and Microsoft Office Suite (particularly Excel).
  • In-depth knowledge of healthcare revenue cycle management, insurance claims, and financial compliance.
  • Ability to work independently and manage multiple priorities in a fast-paced environment.