Summary:
Responsible for the overall functioning of the BU- Business center by providing efficient leadership, proper planning and encouraging the staff of the section to follow departmental policies and procedures.
The Business Center Head is responsible for overseeing and optimizing all revenue cycle functions of the hospital, including front-end and back-end revenue operations, medical billing, claims management, payers relations, and charge master control. The role ensures timely and accurate revenue capture, minimizes denials, improves collections, and supports overall business growth.
Functional Responsibilities:
- Ensures through his/her actions, either directly or indirectly that a superior quality of medical treatment, compassion and understanding is given to every patient served at the NMC Hospitals and Clinics.
- Managing Front -End Revenue
- Authorization Section
- Upfront Collection
- Managing Back -End Revenue
- In & Out Patients Medical Billing
- Claim Managements.
- Account Receivable
- Review, revise & control the Charge master.
- Close coordination with Business Development department to implement the new payer's contracts.
- Finalize yearly settlement with the insurance companies, Government Payers (MOH, SFH ...etc.)
- Control the difficult discharge and self-pay not collected patients
- Ensure up to date record of the following:
- Monthly closing of the Medical Billing
- Accomplishment report
- Quality indicator report
- Statement of account (Payers ,Patient )
- Review the contracts of all the Insurance / Direct Companies from time to time particularly from the revenue point of view.
- Approves and rechecks all the monthly corporate claims.
- Responsible for the submission of the monthly claims in a timely manner to all the Contracted Companies, whether Direct or Insurance companies.
- Has to oversee that the submitted claims are not rejected / changed by ensuring that the claims are complete in all the aspects with proper documents, investigation results, correct invoices and all other requirements.
- Responsible for the final settlement of the rejected claims with the Insurance Companies / Direct Companies by organizing meetings with their concerned officials and report the final status of the settlement to the Director, Business Center.
- Responsible for printing the various monthly reports for monitoring of the sections functioning and initiate steps to improve whenever indicated.
- Meets current objectives and positions the organization for future growth. Completes daily tasks and assignments and processes large volumes of work associated with the operation of the department.
- Builds positive relationships based on respect for others. Demonstrates a helpful positive attitude. Maintains effective communication with peers, staff and visitors.
- Meets and exceeds expectations of internal and external customers. All organizational and departmental standards regarding quality of performance are met. Demonstrates a strong commitment to confidentiality. Participates in quality improvement programs as directed.
- Follow all applicable polices and procedure of CMC.
- Performs additional tasks and duties as assigned by Superiors and flexible to work in all CMC Business Units.
Job Specifications
Minimum Job Qualifications Requirement (Academic, Certifications, languages, etc.)
Education:
Required
- Bachelor's degree in Accounting, Finance, Healthcare Administration, or a related field.
Desirable
Bachelor's degree in Information Technology, Computer Science, or related field preferred.
Minimum Work Experience:
- Ten (10) years experience in a similar field in large scale hospital setting. Including 5 years as a managerial role
- Experience in the same field or working experience with an Insurance company
- Strong knowledge of payer contracts, healthcare billing processes, medical coding, and AR management.
- Experience with government payers (MOH, SFH, etc.) and private insurance companies.
- Strong understanding of Saudi health insurance systems, including CCHI, and MOH claim workflows.
Certifications (Preferred):
- CCHI Certification or training in medical insurance
- Basic training in medical billing and coding
Skills & Competencies:
- Strong leadership and team management
Revenue cycle expertise
- Analytical and problem-solving skills
- Negotiation and payer relations skills
- Communication and interpersonal skills
- Attention to detail and accuracy
- Ability to work under pressure and manage high volumes of work
- Commitment to confidentiality and service excellence
