RCM Specialist

Role Overview

Waseel is seeking an RCM Specialist to join the team in different regions around the Kingdom. As an RCM Specialist, you will be responsible for managing the revenue cycle of healthcare provider organizations, ensuring efficient billing and collections processes.

Role Purpose

Manage the revenue cycle of healthcare provider organizations by monitoring compliance, validating patient information, processing approvals and reports, and ensuring completeness and accuracy in the claims process.

Key Responsibilities

Compliance & Monitoring

• Monitor compliance to ensure protocols align with standard CCHI policies.

Data Entry & System Management

• Validate and enter patient information and insurance coverage into appropriate computer systems.
• Work on the Naphies platform with a highly skilled professional team.

Claims Processing & Documentation

• Send approvals and reports to insurance companies.
• Handle Ministry of Health cases by submitting all necessary documents and investigations to support approval requests made by the treating doctor.
• Analyze data on UCAFs before submitting to insurance companies.
• Review insurance claim forms and supporting documents to ensure completeness and continuity in the claims process.

Clinical & Technical Support

• Provide medical guidance to the claims processing team.
• Assist with ICD coding.

Qualifications & Experience

• Bachelor's degree required.
• Previous experience in revenue cycle management and medical approvals highly desirable.
• Mid-level positions require a minimum of 2 years of experience.
• Certified Professional (IFCE) required.
• Certified Professional (RCM) required.

Skills & Competencies

• Proficiency in approval platforms essential.
• Strong analytical and problem-solving skills with the ability to identify and resolve billing issues.
• Excellent verbal and written communication skills.
• Excellent interpersonal skills enabling effective collaboration with multidisciplinary teams.