The Medical City (TMC) is searching for an experienced Head of Revenue Cycle Management (RCM) / Commercial Sales to be part of the team that leads the organization to the next level. This role is is responsible for leading, optimizing, and driving revenue generation and cash flow across the hospital group’s network. This role ensures seamless patient financial services, payer contract negotiations, pricing strategies, revenue integrity, and collections while also identifying and developing new commercial sales opportunities. The position requires a deep understanding of healthcare financing, payer relationships, billing processes, and data-driven decision-making to maximize financial performance.
What’s The Role All About?
Revenue Cycle Management (RCM)
- End-to-End RCM Oversight: Lead and oversee all revenue cycle processes, including patient registration, billing, coding, charge capture, claims processing, denials management, and collections.
- Billing & Claims Optimization: Ensure accurate and timely claims submission to insurers, government programs, and corporate accounts. Reduce denial rates and improve claim adjudication processes.
- Revenue Integrity & Compliance: Ensure compliance with regulatory requirements, payer policies, and internal controls to maximize reimbursement and mitigate risks.
- Technology & Automation: Implement AI, automation, and analytics tools to enhance billing, collections, and denial management efficiency.
- Patient Financial Services: Develop policies for patient payment plans, financial assistance programs, and transparent pricing to improve patient satisfaction and revenue collection.
Commercial Sales
- Payer & Insurance Contracting: Lead negotiations with insurers, government health programs, and corporate health plans to secure competitive rates and reimbursement structures.
- New Revenue Streams: Develop and implement strategies for monetizing healthcare services through partnerships, corporate accounts, and employer health programs.
- Market Expansion: Identify growth opportunities such as wellness programs, preventive healthcare packages, telehealth solutions, and concierge healthcare services.
- Corporate & Institutional Sales: Build and maintain relationships with key corporate clients, embassies, TPAs (Third-Party Administrators), and government agencies to drive commercial revenue.
- Pricing Strategy & Packages: Design bundled service offerings and dynamic pricing models to enhance affordability while maximizing margins.
Strategic Leadership and Team Management
- Team Development: Lead, mentor, and manage a high-performing RCM and sales team to ensure excellence in revenue generation and collections.
- Stakeholder Engagement: Work closely with hospital leadership, finance, operations, and clinical teams to align revenue goals with overall business strategy.
- Performance Tracking & KPIs: Develop and implement key performance indicators (KPIs) for revenue cycle performance, collection efficiency, and commercial sales targets.
Key Performance Indicators (KPIs)
- Net revenue realization rate
- Claims denial rate and turnaround time
- Days in accounts receivable (AR)
- Collection efficiency and bad debt reduction
- Corporate client acquisition and retention rate
- Payer contract negotiation success rate
- Growth in new revenue streams
Who Are We Looking For?
An effective Head of Revenue Cycle Management (RCM) / Commercial Sales must possess the following:
- Education: Bachelor’s degree in business, Healthcare Administration, Finance, or a related field. Master’s degree (MBA/MHA) preferred.
- Experience: Minimum 10 years of progressive experience in revenue cycle management, healthcare finance, or commercial healthcare sales, with at least 5 years in a leadership role.
- Industry Knowledge: Strong understanding of hospital billing, payer negotiations, coding (ICD-10, CPT), and healthcare regulations.
- Technical Skills: Experience with RCM software, ERP systems, and healthcare analytics tools.
- Leadership & Communication: Excellent stakeholder management, negotiation, and team leadership skills.