Medical Biller / Claim Officer (RCM)

National Blood & Cancer Center - NBCC; Riyadh; On-site; SAR 150,000 - 200,000; Full time

Job summary

A leading healthcare facility in Saudi Arabia is seeking a Revenue Cycle Management (RCM) Specialist to streamline financial operations. This role involves verifying patient information, preparing medical claims, and ensuring compliance with regulations. Ideal candidates will have a bachelor's degree along with a minimum of 5 years experience in healthcare billing and possess excellent analytical and communication skills. Join us to enhance the financial stability of our center while contributing to high-quality patient care.

Qualifications

• Minimum 5 years of experience in healthcare revenue cycle management or medical billing.
• Strong knowledge of medical coding and billing regulations.
• CPC, CPB, or RCM certifications are preferable.

Responsibilities

• Verify patient demographic and insurance information at registration.
• Prepare and submit accurate medical claims to insurance companies.
• Monitor claim status and resolve payment issues.
• Collaborate with clinical staff, coding specialists, and finance team.

Skills

Analytical skills

Problem-solving skills

Communication skills

Interpersonal skills

Attention to detail

Education

Bachelor’s degree in healthcare administration, Business Administration, Finance, or a medical field

Tools

Medical Billing Software

Job description

Role Overview

Play a key role in streamlining our financial operations as a Revenue Cycle Management (RCM) Specialist, guaranteeing accurate and timely billing, coding and claims submission. This position has a direct impact on our center's capacity to deliver high-quality patient care and is essential to its financial stability. In order to maximize revenue capture and ensure compliance with all regulatory standards, you will be in charge of doing the many phases of the revenue cycle, from insurance verification to claim processing, and rejection management.

Key Job Responsibilities

• Verify patient demographic and insurance information for accuracy and completeness at the point of registration.
• Confirm patient eligibility, benefits, and pre-authorization requirements with insurance providers for all oncology and hematology services.
• Prepare, review, and submit accurate and timely medical claims to various insurance companies using appropriate coding.
• Ensure all claims comply with payer-specific guidelines, coding regulations, and CHI standards and Saudi Coding system.
• Monitor claim status and resolve any issues that may delay payment.
• Analyze rejected claims to identify root causes and implement corrective actions.
• Prepare and submit effective appeals to insurance companies for rejection claims, providing necessary documentation and justification.
• Track rejection trends and report findings to the Revenue Cycle Manager to improve future claim submission processes.
• Stay updated on changes in healthcare regulations, coding guidelines, and payer policies to ensure continuous compliance.
• Generate reports on revenue cycle performance, including key metrics such as days in A/R, denial rates, and collection rates.
• Identify opportunities for process improvement to enhance efficiency and revenue capture.
• Collaborate closely with clinical staff, coding specialists, finance department and customer services teams to ensure accurate documentation and smooth information flow throughout the revenue cycle.
• Participate in team meetings and contribute to discussions on revenue cycle optimization strategies.

Job Requirements

• Bachelor’s degree in healthcare administration, Business Administration, Finance, or a medical field; equivalent experience may be considered.
• Minimum of 5 years of experience in healthcare revenue cycle management, medical billing, or collections, preferably in an oncology or specialty care setting.
• Strong knowledge of medical coding and billing regulations.
• CPC, CPB or RCM certifications are preferable.
• Excellent analytical, problem-solving, and organizational skills.
• Strong communication and interpersonal skills, with the ability to explain complex billing information clearly to patients and staff.
• Detail-oriented with a high degree of accuracy.
• Ability to work independently and as part of a team in a fast-paced environment.