Sr. Revenue cycle officer, Sr. Receivable Accountant, Sr. Insurance and Billing officer, RCM
Tawam Hospital
Total des années d'expérience :18 years, 2 Mois
Core member of Hospital and corporate office’s (SEHA) Information System network (Cerner, USA) development Team. Working with Cerner/SEHA team on implementation of Cerner Revenue Cycle Management / profit module (Patient Billing and Accounting) as “Application Specialist”. Mainly to be used for electronic insurance claims submission, charge calculation of hospital billable services through all hospital HIS activities/modules, revenue calculation, linking of revenue with G.L accounts & cost centre. Patient accounting (Profit) system integration with all other Cerner modules including Registration, ER, Lab, Radiology, surgery, HIM (Coding) etc. Initiating and maintaining charge master updates and changes as per Health Authority, third party payer’s requirements as necessary in the Cerner system. Providing feedback on charge master for clinical procedures, diagnosis and treatment codes and ensuring that codes are aligned with respective ICD9 / CPT in Cerner System. Coordinating with other RCM staff to address issues identified in the Cerner Profit and Charge Services Applications and assists with training of hospital staff on Cerner Charge Services and Profit (patient Accounting) Applications. Develop and maintain system training manuals. Assist with post-implementation troubleshooting and problem solving. Review of available reports in Cerner patient accounting system and designing of new Financial Reports for top management. Member of hospital and corporate (SEHA) Revenue Cycle Committee. Actively
involved in staff education and training for revenue cycle issues. Developed internal
Processes and controls for billing and revenue generation. Coordinating with Patient
affairs, registration, HIM (coders), physicians, case managers, Pre-authorization
team, supply chain department and billers for revenue cycle issues and billing processes. Involved in coding audit for hospital licensing that includes E&M, ICD-9
and IR-DRG coding and billing. Engaged with 3M (USA) project for E&M and insurance denial review to reduce the hospital’s insurance claim’s denials. Training and educating hospital staff as per insurance contract’s requirement and claiming process. Reviewing and coordinating insurance denials trends with all concern departments. Developed insurance billing process for the whole region and the hospital. Developed Insurance electronic claim generation and submission process. Follow up of receivable. Reconciliation with insurance companies. Supervising a team of 60 billers/claim processors, cashiers and other receivable staff. Supervising timely insurance claims generation and submission. Dealing with more than 20 multinational insurance companies. Preparing statement of denied claims, denial’s resubmission and payments from insurance companies. Self pay billing and payment follow up. Following billing process of sponsored patients and their receivable. Supervising the cashiers daily activities. Monitoring cash collection and bank deposits. Coordinating with budget department for annual and monthly budget. Preparing and reviewing job descriptions of junior finance staff (Billers, Clerks & Cashiers). Preparing monthly, quarterly and annual receivable reports for the management. Coordinating with internal and external auditors. Ensuring reconciliation between general ledger control accounts with accounts receivable subsidiary ledger. Ensuring that accurate books and records are maintained at all times in accordance with established policies and procedures and internal accounting standards. Coordinating and participating in reviewing in accounts receivable policies and procedures on regular bases. Providing statistical analysis of payment data as needed from different resources. Provide inputs for committees, panels and task forces as required. Acting as back up in absence of Receivable manager. Working as acting in absence of Director Revenue Cycle. Reporting to Financial Controller and Revenue Cycle Director.