Insurance & Revenue Cycle Management (RCM) Director

Job Summary

Contract Management & Strategic Partnerships

• Policy Review & Optimization: Regularly review and evaluate current insurance policies to protect the Center’s financial interests and secure optimal reimbursement rates.
• Network Expansion: Identify, negotiate, review and establish new contracts and agreements with medical insurance companies and third-party administrators (TPAs) not currently in the network.
• Relationship Management: Build and maintain strong, long-term strategic relationships with key stakeholders at insurance firms to secure competitive pricing and favorable terms.

Operational Management (Claims & Approvals)

• Approvals & Claims Supervision: Oversee the end-to-end workflow of medical approval requests and ensure accurate, timely submission of financial claims to payers.
• Rejection Management: Analyze the root causes of medical and technical rejections and implement corrective action plans to minimize rejection and steadily increase the "Approval Rate."
• Financial Reconciliation: Follow up on collections, settlements, and aging accounts receivable with insurance companies to resolve discrepancies and accelerate cash flow.

Financial Analysis & Revenue Growth

• Revenue & Profitability Analysis: Analyze the revenue share and financial performance of each insurance provider to identify high-yield versus low-performing payers.
• Annual Growth Targets: Develop and execute strategic pricing and negotiation tactics to ensure sustainable annual revenue growth from insurance channels.
• RCM Cross-Functional Collaboration: Coordinate closely with clinical and ancillary departments (Physicians, Nursing, Pharmacy) to improve medical documentation and data quality, directly accelerating the revenue cycle and eliminating revenue leakage.

Reporting

• Periodic Reporting: Prepare and present comprehensive performance reports (weekly/monthly/quarterly) to executive management, highlighting RCM efficiency, rejection/approval metrics, payer-specific growth, and strategic recommendations.

Job Requirements & Qualifications

• Bachelor’s degree in medicine & surgery, Pharmacy, Healthcare Management, or a related field. A Master’s degree (MBA/MHA) or professional certification in health insurance/RCM is highly preferred.
• Experience: Minimum of 5 to 7 years of progressive experience in medical insurance management within a major hospital or specialized medical center. Prior experience in oncology or chronic disease centers is a significant advantage.
• Negotiation Skills: Proven track record of successfully negotiating high-value medical contracts and securing profitable terms for healthcare providers.
• Analytical Skills: Advanced capability in financial data analysis, utilizing key performance indicators (KPIs) to drive operational decisions.
• Regulatory Knowledge: Deep understanding of local health insurance laws, regulations (e.g., Council of Health Insurance - CHI rules), and medical coding standards (such as ICD-10-AM).
• Strong leadership, communication, and interpersonal skills to bridge the gap between clinical teams and insurance corporations.
• Full professional proficiency in both Arabic and English (written and spoken).
• Advanced proficiency in Hospital Information Systems (HIS) and data analysis tools (such as advanced MS Excel or BI tools).