Outpatient Medical Facility Manager
Skills
About This Role
Overview
- Manage the entire revenue cycle: registration, eligibility, coding, charge capture, billing, claims submission, denial management, collections, and reporting.
- Ensure accurate data flow from clinical departments (radiology, labs, radiotherapy, clinics).
- Lead the implementation and optimization of RCM workflows within HIS/RIS/LIS systems.
B. Insurance & Payer Management
- Maintain strong relations with insurers (cooperative health insurance companies, TPAs).
- Ensure compliance with CCHI, NHIC, and MOH regulatory requirements.
- Monitor payer contract performance, reimbursement trends, and tariff updates.
- Manage pre-authorization workflows for radiology, lab, and radiotherapy services.
C. Coding & Compliance
- Ensure correct application of ICD-10, CPT, HCPCS, and local coding standards.
- Work with clinical teams to ensure proper documentation for high-cost treatments such as radiotherapy.
- Conduct regular audits to ensure coding and billing accuracy.
D. Claims & Denial Management
- Oversee timely submission of electronic and manual claims to payers.
- Analyze reasons for rejections/denials and implement corrective actions.
- Reduce AR days, improve collection rates, and minimize write-offs.
- Ensure reconciliation of submitted claims, remittances, and payments.
E. Patient Billing & Cash Management
- Oversee self-pay billing, discounts, co-pay collections, and financial counseling.
- Ensure transparent pricing for imaging, labs, and home services.
- Manage POS collections at clinics and home-service teams.
F. Reporting & Performance Monitoring
- Develop weekly and monthly RCM KPIs, including:
- AR aging
- Clean claim rate
- Denial rate & root causes
- Days in AR
- Collection rate
- Provide analytical insights to management to improve revenue performance.
- Forecast revenues and support budgeting processes.
G. Team Leadership
- Manage and train staff in registration, billing, coding, approvals, and collections.
- Implement performance review systems and continuous improvement programs.
- Collaborate closely with radiology, lab, oncology, home services, and finance teams.
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