Rcm Case Manager

2 months ago


Dubai, United Arab Emirates AccuMed Full time

**Role Summary**:
A case manager is responsible and plays a crucial role in ensuring the financial health and efficiency of the organization. The primary responsibilities of this role include overseeing and managing various aspects of the revenue cycle to optimize reimbursement and minimize financial risks of all in-patient cases

**Key Responsibilities**:
1. Responsible for reviewing clinical documentation, admission and discharge reports and following up with Pre-Approval Teams to ensure that updated approvals are submitted to insurance companies prior to patient discharge.

2. Collaborates with onsite clinical teams to ensure that Pre-Approval and Clinical Coding Teams are informed in the event of a change in the patient’s status.

3. Reviews clinical documentation and provides evidence-based responses for approval rejections or rejections to an increase in patient length of stay or change in approval.

4. Follows up on clinical queries submitted by Revenue Cycle Teams to Clinicians.

5. Reviews clinical documentation upon admission and throughout a patient’s stay in the hospital, identifies deficiencies in documentation that could impact clinical coding or initial approval, and follows up with physicians to ensure that documentation deficiencies are corrected.

6. Claims and Billing Oversight:

- Collaborate with billing teams to ensure accurate and timely submission of claims to insurance providers, government agencies, and other payers.
- Verify the completeness of claims, ensuring adherence to coding and billing standards.

7. Complex Case Resolution:

- Handle complex cases related to billing discrepancies, denied claims, pre-approval and payment disputes.
- Work closely with internal staff, insurers, and external stakeholders for prompt and effective issue resolution.
- Provide clear communication on case outcomes to relevant parties.

8. Policy Compliance and Regulatory Adherence:

- Stay informed about healthcare regulations, reimbursement policies, and industry best practices.
- Implement and ensure compliance with relevant policies and procedures in their scope of service.
- Conduct regular audits to verify adherence to compliance standards and address any issues.

9. Patient Communication and Advocacy:

- Collaborate with patients to address billing inquiries and provide transparent explanations of charges.
- Facilitate the resolution of financial concerns, helping, and guidance.
- Advocate on behalf of patients to ensure fair and accurate billing practices.

10. Process Improvement Initiatives:

- Identify opportunities for process improvement in the revenue cycle.
- Propose and implement changes to enhance efficiency and accuracy in billing and claims management.
- Regularly review and update processes to align with industry best practices.
- Liaise with physicians internally to expedite cases and resolve preapproval issue and ensure smooth process for all insurance patients

11. Cross-Departmental Collaboration:

- Work closely with finance, coding, and clinical teams to ensure a seamless and integrated approach to revenue cycle management.
- Facilitate communication and collaboration between departments, physicians and patients to streamline processes.
- Address inter-departmental challenges and implement solutions collaboratively.

12. Training and Education:

- Provide training sessions for staff on updated billing and coding procedures.
- Educate staff on compliance requirements and changes in regulations affecting the revenue cycle.
- Foster a culture of continuous learning to ensure staff remains informed and proficient.

13. Performance Metrics Monitoring:

- Develop key performance indicators (KPIs) to track the effectiveness of revenue cycle management efforts.
- Regularly monitor KPIs and analyze performance metrics.
- Implement adjustments and improvements based on performance data to enhance overall efficiency.

14. To undertake any additional tasks assigned by the line manager in accordance with operational requirements.

**Job Requirements**:

- Bachelor's or master’s degree in business administration, Operations Management, or a related field.
- CPC or CCS AHIMA degree in coding and guidelines.
- Medical knowledge or medical background is an added asset.
- Proven track record for 4 to 5 years in a similar role as case manager in the hospital sector.
- Extensive case management experience in resolving billing discrepancies and denied claims.
- In-depth knowledge of healthcare compliance, regulations, and reimbursement policies.
- Successful history of conducting financial analyses and implementing strategies for improved financial performance.
- Demonstrated expertise in identifying and implementing process improvements.
- Proficient in coding and billing procedures, ensuring accuracy and compliance.
- Exceptional analytical skills for interpreting financial data and making informed decisions.
- Effective communication skills, both written and verbal.
- Strong collaborat


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