Outpatient Medical Facility Manager

Radcare Health

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.