RCM (Revenue Cycle Management) Manager / Specialist

Industry: Healthcare Services / Hospital Insurance / Healthcare BPO

Department: Healthcare Operations / Revenue Cycle Management

Experience: 3–10 Years (based on position)

Qualification: Bachelor's degree in Healthcare Management, Hospital Administration, Commerce, Finance or a related field.

Job Summary The RCM professional will be responsible for managing and improving the complete revenue cycle operations of hospitals, ensuring timely claim submissions, insurance approvals, payment collections and settlement of outstanding dues.

The role involves coordinating with hospitals, insurance companies, TPAs, billing teams and healthcare service providers to minimize claim rejections, improve cash flow and ensure effective revenue management.

Key Job Responsibilities

Revenue Cycle Management

1. Manage the complete revenue cycle process, from patient registration to final payment collection.
2. Monitor hospital revenue generation, billing and collection processes.
3. Ensure accurate and timely processing of hospital bills and insurance claims.
4. Identify revenue leakages and implement corrective measures.
5. Improve revenue cycle efficiency and reduce payment delays.

Insurance Claims Management

1. Manage insurance claims submission, processing and settlement.
2. Coordinate with insurance companies and TPAs for claim approvals.
3. Verify insurance eligibility, policy coverage and patient benefits.
4. Follow up on pending, rejected and disputed insurance claims.
5. Ensure proper documentation for cashless and reimbursement claims.
6. Resolve claim discrepancies and minimize claim rejections.

Accounts Receivable (AR) Management

1. Monitor outstanding insurance and patient receivables.
2. Follow up with insurance companies and TPAs for pending payments.
3. Manage ageing reports and outstanding dues.
4. Develop strategies to improve collections and reduce AR days.
5. Reconcile payments received against submitted claims.

Denial Management

1. Analyse rejected and denied insurance claims.
2.



Identify the reasons for claim denials and payment deductions.
3. Coordinate with hospital departments to correct billing and documentation errors.
4. Prepare and submit claim appeals and resubmissions.
5. Implement processes to reduce recurring claim rejections.

TPA & Insurance Coordination

1. Maintain strong relationships with insurance companies and TPAs.
2. Coordinate for pre-authorizations, claim approvals and final settlements.
3. Handle insurance queries, escalations and payment disputes.
4. Ensure timely communication between hospitals, insurers and TPAs.
5. Support empanelment and renewal processes with insurance providers.

Hospital Billing & Documentation

1. Supervise hospital billing and medical documentation processes.
2. Ensure accurate preparation of invoices and supporting documents.
3. Verify billing details against treatment records and approved packages.
4. Ensure compliance with insurance guidelines and hospital billing policies.
5. Coordinate with doctors, billing teams and medical records departments.

Credit & Cash Flow Management

1. Monitor hospital credit outstanding and insurance receivables.
2. Ensure timely settlement of hospital credit bills.
3. Track payment commitments and collection timelines.
4. Identify potential financial risks and delayed payments.
5. Improve hospital cash flow through effective collection management.

Reporting & MIS

1. Prepare daily, weekly and monthly RCM performance reports.
2. Monitor claim submission, approval and rejection rates.
3. Analyse collection efficiency and outstanding receivables.
4. Prepare insurance-wise and TPA-wise performance reports.
5. Present operational performance and improvement plans to management.

Team Management & Process Improvement

1. Manage and supervise RCM executives, billing staff and insurance coordinators.
2. Allocate responsibilities and monitor team performance.
3. Train employees on insurance claims, billing and RCM procedures.
4. Establish SOPs for claims processing and collection activities.
5. Implement process improvements to increase productivity and accuracy.

📌 Revenue Cycle Management Manager-Kochi-For a Healthcare Service Co.
🏢 Populux HR
📍 Kochi