Reconciliation Manager

Job Purpose

Organizational Accountabilities

• Ensure accuracy and integrity of financial and revenue reconciliation processes.
• Support compliance with CCHI, NPHIES, and Saudi healthcare regulations.
• Minimize revenue leakage and discrepancies between billing and collections.
• Strengthen financial controls and reconciliation governance.
• Support audit readiness and regulatory reporting requirements.
• Contribute to overall revenue cycle efficiency and financial performance.

Revenue & Payment Reconciliation

• Oversee reconciliation of billed services against payments received from insurance companies and patients.
• Ensure alignment between claims submitted, remittances, and collections.
• Identify and resolve discrepancies, variances, and unmatched transactions.

Insurance & Payer Reconciliation (CCHI / NPHIES)

• Manage reconciliation of claims processed through NPHIES.
• Validate remittance advices and payment details against submitted claims.
• Ensure compliance with payer contracts, tariffs, and CCHI policies.

Denials & Variance Analysis

• Analyze payment variances, short payments, and denied claims.
• Collaborate with revenue cycle teams to address root causes.
• Monitor trends and recommend corrective actions to reduce discrepancies.

Financial Controls & Governance

• Establish and maintain reconciliation controls and procedures.
• Ensure segregation of duties and audit trails are maintained.
• Support internal and external audits with required documentation.

Reporting & Performance Monitoring

• Prepare reconciliation reports, variance analysis, and financial summaries.
• Monitor KPIs such as reconciliation accuracy, variance rates, and recovery performance.
• Provide insights to management for decision-making.

System & Data Management

• Ensure data accuracy across billing systems, HIS, and financial systems.
• Coordinate with IT to resolve system discrepancies or integration issues.
• Support automation of reconciliation processes.

Stakeholder Coordination

• Collaborate with Finance, Revenue Cycle, HIM, and Operations teams.
• Liaise with insurance companies and TPAs regarding discrepancies.
• Support resolution of complex reconciliation issues across departments.

Key Internal Stakeholders

• Commercial Department Leadership.
• Finance and Accounting.
• Revenue Cycle Management (Billing, Coding, Claims, and Collections).
• Health Information Management (HIM).
• IT and Systems Teams.
• Internal Audit and Compliance.

Key External Stakeholders

• Insurance companies and Third-Party Administrators (TPAs).
• CCHI / NPHIES-related entities.
• External auditors.
• System vendors.

Job Qualifications and Requirements

• Knowledge and Experience
• 7–10 years of experience in reconciliation, finance, or revenue cycle management.
• Experience within the healthcare sector or insurance environment is preferred.
• Strong knowledge of CCHI regulations, NPHIES workflows, and payer reconciliation processes.
• Experience in claims management, billing, and financial reconciliation.
• Strong understanding of healthcare tariffs, contracts, and reimbursement models.
• Experience with ERP systems and healthcare billing systems.

Education

• and Certifications
• Bachelor’s degree in Finance, Accounting, Health Administration, or a related field.
• CPA / CMA / SOCPA certification (Preferred).
• Certified Revenue Cycle or Healthcare Finance certifications (Preferred).
• Training in CCHI / NPHIES processes (Preferred).
• IFRS or financial reporting certifications (Preferred).