Revenue Cycle Manager (RCM) - Corporate Services at Intercare Group South Africa

DUTIES & RESPONSIBILITIES

Revenue Cycle Oversight:

• Manage the full revenue cycle, including patient registration, charge capture, claims submission, payment posting, and collections.
• Ensure accurate and timely billing to medical aid schemes, patients, and third-party payers.

Claims Management:

• Oversee submission and follow-up of claims to medical aid schemes (e.g., Discovery, GEMS) and government bodies, minimising rejections and resubmitting rejected claims efficiently.
• Monitor and improve claim approval rates and revenue recovery timelines.

Financial Performance:

• Optimise cash flow by reducing days in accounts receivable and addressing revenue leakage (e.g., unbilled services, uncollected co-payments).
• Prepare and analyse revenue cycle reports, providing insights to senior management on KPIs such as debtor days, collection rates, and bad debt ratios.

Compliance and Coding:

• Ensure adherence to South African healthcare regulations (e.g., Council for Medical Schemes guidelines, National Health Act) and readiness for National Health Insurance (NHI) developments.
• Supervise accurate use of billing codes (e.g., ICD-10, procedural tariffs) to support compliant and successful claims.

Team Leadership:

• Lead, train, and motivate the RCM team, fostering a culture of accuracy, efficiency, and patient sensitivity.
• Develop staff skills in medical billing, coding, and customer service.

Process Improvement:

• Implement and maintain RCM systems (GoodX, SharePoint, PowerBI) to streamline workflows and enhance automation.
• Identify and address inefficiencies in the revenue cycle, collaborating with clinical and administrative teams to improve payment allocation, payment methods, patient communication, and registration processes.

Stakeholder Collaboration:

• Work closely with patient administration, clinical staff, and IT teams to ensure seamless revenue cycle operations.
• Liaise with medical aid schemes and external partners to resolve payment disputes and improve reimbursement processes.

Patient Experience:

• Oversee patient billing communications, ensuring clarity and sensitivity, particularly for underserved or uninsured patients.
• Address patient queries related to billing or medical aid shortfalls in a professional and empathetic manner.

REQUIREMENTS

Education:

• Bachelor’s degree in Finance, Accounting, Healthcare Management, or a related field.
• Additional certification in medical billing/coding (e.g., ICD-10 certification) or revenue cycle management is highly advantageous.

Experience:

• Minimum of 5 years’ experience in revenue cycle management, billing, or financial management within a healthcare setting.
• At least 2 years in a supervisory or managerial role.
• Proven track record of managing claims with South African medical aid schemes and improving revenue outcomes.

Technical Skills:

• Proficiency in RCM or financial software (e.g., GoodX, Sage) and Microsoft Office (especially Excel).
• Strong understanding of South African healthcare billing codes (ICD-10) and medical aid processes.

Knowledge:

• In-depth knowledge of South African healthcare regulations (e.g., CMS, NHI framework) and financial reporting standards (e.g., IFRS).
• Familiarity with socio-economic challenges affecting patient payments in South Africa.