Finance & Revenue Cycle Management (RCM) Specialist
Position Summary
The Finance & Revenue Cycle Management (RCM) Specialist will oversee and manage all financial, collection, and insurance claim activities within a healthcare environment. This role is responsible for ensuring the accurate, timely, and transparent validation of invoices, submissions, payments, collections, quotations, and insurance claims across healthcare providers and insurers.
The position requires close coordination with healthcare operations teams, insurers, service providers, and internal stakeholders to ensure compliance, minimize claim rejections, improve collection timelines, and support financial sustainability.
Key Responsibilities
Financial Oversight
- Review and validate all invoices submitted by service providers for accuracy, completeness, and contractual compliance.
- Review and validate quotations for services and ensure alignment with approved contractual terms.
- Collaborate with Finance and leadership teams on budget adherence, forecasting, and expenditure control.
- Lead the preparation, monitoring, and management of annual budgets in alignment with organizational strategic and operational goals.
- Prepare monthly financial analysis and variance reports, including recommendations for corrective actions.
- Ensure timely submission and processing of work completion certificates, invoices, and related financial documentation.
- Provide regular updates on operational financial status, including CAPEX, OPEX, contractor payments, insurance payments, governance-related expenditures, and accreditation-related costs.
- Ensure timely collection and reconciliation of accrued revenue and accounts payable.
- Monitor CAPEX and OPEX allocation to ensure projects and procurement activities are executed within approved budgets and timelines.
Insurance & Revenue Cycle Management
- Oversee the monthly insurance claim submission process across multiple insurance providers.
- Validate claim accuracy, completeness, and compliance with insurer requirements.
- Monitor claim rejection rates and implement corrective action plans to reduce denials and improve reimbursement timelines.
- Lead reconciliation meetings with insurers and service providers to resolve payment discrepancies.
- Ensure transparency, accountability, and compliance throughout the claim submission and payment process.
- Ensure timely collection and reconciliation of incurred and accrued claims revenue.
Reporting & Analysis
- Prepare and present financial and insurance performance reports to senior management.
- Track and monitor key performance indicators (KPIs) related to finance, revenue cycle management, and collections.
- Identify risks, inefficiencies, and opportunities for revenue optimization and cost control.
- Support decision-making through financial modeling, forecasting, and data-driven analysis.
Leadership & Stakeholder Management
- Serve as the primary point of contact for financial and insurance-related matters with insurers and service providers.
- Work closely with healthcare operations, finance, and leadership teams to align financial and operational objectives.
- Facilitate collaboration among internal and external stakeholders to improve financial performance and revenue cycle efficiency.
- Support internal and external audits and ensure compliance with financial policies, procedures, and regulatory requirements.
Additional Responsibilities
- Support administrative activities related to finance and revenue cycle management when required.
- Perform any other duties assigned by management.
Qualifications
Education
- Bachelor's Degree in Finance, Accounting, or a related field (required).
- Master's Degree in Finance, Accounting, Business Administration, or related discipline (preferred).
Professional Certifications
One or more of the following certifications is preferred:
- CPA (Certified Public Accountant)
- CMA (Certified Management Accountant)
- ACCA
- CIMA
Experience
- Minimum 6 years of relevant experience.
- At least 3 years in a lead or supervisory role.
- Proven experience in healthcare finance, insurance operations, or revenue cycle management.
- Strong experience in budgeting, financial planning, forecasting, and financial reporting.
- Hands-on experience with insurance claims processing, validation, reconciliation, and collections.
- Demonstrated experience managing healthcare-related budgets and financial controls.
Required Competencies
- Strong analytical and financial management skills.
- Advanced knowledge of healthcare insurance claims and revenue cycle processes.
- High attention to detail with the ability to identify errors, discrepancies, and financial risks.
- Advanced Microsoft Excel skills, including:
- Pivot Tables
- VLOOKUP/XLOOKUP
- Advanced Formulas
- Financial Modeling
- Data Analysis and Reporting
- Strong negotiation, communication, and stakeholder management skills.
- Ability to work effectively with cross-functional teams, service providers, and insurance companies.
- Strong problem-solving and decision-making capabilities.
