The Finance & RCM Specialist is responsible for overseeing financial, billing, insurance claims, and revenue cycle activities. The role ensures accurate and timely invoice and claim validation, effective financial controls, budget adherence, and strong coordination with the healthcare operator, insurers, and internal Finance teams.
Key Responsibilities
Financial Management
- Review and validate operator invoices and quotations for accuracy, completeness, and contractual compliance.
- Support annual budgeting, forecasting, expenditure monitoring, and cost control.
- Prepare monthly financial analysis, budget-versus-actual reports, and variance analysis.
- Identify financial risks, discrepancies, and opportunities for cost optimization.
Insurance & Revenue Cycle Management
- Oversee monthly insurance claim submissions and ensure accuracy and compliance with insurer requirements.
- Monitor claim rejections, denials, outstanding claims, and collection timelines.
- Coordinate with the operator and insurers to resolve claim discrepancies and improve collections.
- Lead regular claim reconciliation and follow-up activities.
- Identify opportunities to reduce revenue leakage and improve RCM performance.
Reporting & Compliance
- Prepare financial and insurance performance reports and monitor key KPIs.
- Provide insights and recommendations to senior leadership.
- Support internal and external audits and ensure compliance with applicable policies, contracts, and regulations.
- Maintain accurate documentation and transparency across financial and claims processes.
Stakeholder Management
- Act as the key contact for financial and insurance matters with the healthcare operator and insurers.
- Collaborate with the Head of Health, Operations Manager, Finance, and other relevant stakeholders to achieve financial and operational objectives.
Qualifications
- Bachelor’s degree in Finance, Accounting, Business Administration, or a related field; Finance/Accounting preferred.
- Master’s degree in Finance or a related field is an advantage.
- Professional certification such as CPA, CMA, or ACCA is an advantage.
Experience
- Minimum 6 years of relevant experience, including at least 3 years in a lead or senior role.
- Experience in healthcare finance, insurance, billing, or revenue cycle management.
- Strong experience in budgeting, financial analysis, reporting, claims validation, and reconciliation.
Key Competencies
- Strong financial and analytical skills.
- Good knowledge of healthcare insurance and RCM processes.
- Advanced Microsoft Excel skills, including formulas, pivot tables, and data analysis.
- Strong attention to detail and problem-solving skills.
- Excellent communication, negotiation, and stakeholder management skills.
- Ability to work effectively with healthcare operators, insurers, and internal teams.