Roles & Responsibilities

1. Business Process & Operations

Map and design the end‑to‑end RCM process from patient registration to final payment (self‑pay and insurance).

Analyze current‑state workflows (front desk, clinical, coding, billing, insurance) and define optimized future‑state processes in TrakCare.

Identify revenue leakage points (e.g., missed/late charges, registration errors, authorization gaps) and drive corrective actions.

Work closely with registration, nursing, clinicians, coding, billing, and finance teams to embed standard RCM practices in daily operations.

2. Core RCM & Billing

Ensure accurate charge capture, charge posting, coding, and claim generation across OPD, IPD, ER, day care, and packages.

Support configuration and use of DRG‑based billing, fee‑for‑service, and package/episode billing models.

Collaborate with clinicians and coders to improve documentation quality to support compliant coding and maximum legitimate reimbursement.

Define and monitor key RCM KPIs (clean claim rate, denial rate, unbilled encounters).

3. Saudi Regulations & NPHIES

Act as the RCM focal point for NPHIES‑related workflows (eligibility, prior authorization, claims, remittance).

Translate NPHIES and CHI requirements into practical HIS configuration and workflow steps.

Monitor and manage NPHIES rejections; drive root‑cause analysis and process changes to reduce recurring issues.

Ensure adherence to local regulatory standards, timelines, and data set requirements for claims and approvals.

4. Insurance Contracts & Pricing

Work with finance and contracting teams to configure payer contracts in TrakCare (tariffs, service prices, DRGs, packages, discounts).

Maintain multiple price lists per payer and ensure correct linking to plans, networks, and service types.

Configure and validate rules for exclusions, caps, deductibles, co‑payments, and maximum benefit limits.

Support testing of contract configurations using sample claims before go‑live and during contract changes.

5. Technical & Integration Collaboration

Work closely with IT, vendors, and InterSystems teams to ensure TrakCare RCM modules are correctly configured and integrated.

Validate data flows from registration and clinical modules to billing, insurance, and external systems (e.g., NPHIES, ERP, payer portals).

Participate in interface and integration testing (e.g., FHIR, HL7, APIs, batch/flat file claims) and support troubleshooting of data mismatches.

Provide business input on RCM‑related change requests, enhancements, and issue resolutions.

Desired Candidate Profile

Education & Certification

Bachelor’s degree in Healthcare Management, Finance, Business, or related field.

Coding or RCM‑related certifications (e.g., AHIMA, AAPC, DRG, or equivalent) are preferred.

Experience

5+ years of hands‑on Revenue Cycle Management experience in a hospital setting.

Strong exposure to Saudi insurance market, including major payers and regulations (NPHIES, CHI, Sehey).

Direct experience with HIS/EMR implementations; InterSystems TrakCare experience is a strong plus.

Proven track record in reducing denials, improving clean claim rates, and optimizing RCM processes.

Skills & Competencies

Deep understanding of end‑to‑end hospital RCM (registration, charge capture, coding, billing, claims, collections).

Strong knowledge of OPD, IPD, ER, day‑case, and package billing models, including DRG and fee‑for‑service.

Ability to read and interpret payer contracts and translate them into system configuration.

Excellent communication skills; comfortable working with clinicians, finance, IT, and management.

Strong ownership mindset, problem‑solving ability, and comfort working under time pressure during go‑lives and post go-live support.

Employment Type

Full Time

Company Industry

Medical / Healthcare / Diagnostics / Medical Devices

Department / Functional Area

IT Software