Revenue Cycle Operations

1 week ago

Jeddah, Makkah Province, Saudi Arabia Bupa Full time
Job Description

Is responsible for overseeing the RCM operations including claims and billing management. Communicate partner providers, implement and refine processes of audit and compliance, execute special RCM projects and participate in different analytical activities

Claims and billing management

  • Develop and maintain a strategic approach to the revenue cycle that aligns with the broader objectives of Bupa insurance.
  • Collaborate with clinical and administrative departments to ensure a seamless integration between care delivery and insurance processing systems.
  • Oversee the claims submission process to insurance providers, ensuring accuracy and compliance with insurance policies.
  • Ensure that all claims, denials, and appeals are efficiently processed, and for resolving billing related issues.
  • Identify opportunities to optimize revenue collection and cost management.
  • Deliver metrics and reporting to monitor and improve revenue operations effectiveness.

Partner Providers management

  • Conduct comprehensive market analysis to identify potential partner providers.
  • Establish and maintain robust relationships with providers. Negotiate favorable terms in contracts, provide regular feedback. review and evaluate partner performance against contracts and SLAs
  • Implement strategies to ensure continuous improvement in partner performance.
  • Develop and maintain a comprehensive database of partner providers.
  • Work closely with the legal team to ensure compliance in partner contracts.

Audit and compliance

  • Develop and maintain a compliance risk management plan.
  • Address audit findings with stakeholders and implement corrective actions.
  • Review and update compliance policies and procedures regularly and monitor industry changes.
  • and adjust compliance strategies accordingly.
  • Ensure compliance with Coding & billing regulation.
  • Provides education and policy updates for staff on a regular and as needed basis
  • Conduct on-site audits of selected referral providers to validate the accuracy of documentation and compliance with established protocols.
  • Establish a feedback loop to communicate audit findings with referral providers, addressing areas for improvement and acknowledging positive practices.

Projects management

  • Identify process gaps and propose innovative solutions.
  • Document and implement new workflows and processes.
  • Establish cross-functional collaboration for successful project execution.
  • Conduct regular project review meetings and provide status updates.
  • Ensure project deliverables meet quality standards and organizational objectives.
  • Evaluate project outcomes and capture learnings for future projects.
  • Utilize project management tools and software for efficient tracking.

Healthcare Data Analysis

  • Generate insights in certain healthcare specialties, mine patient and healthcare provider data from multiple sources to discover key analytical insights to create complete views of health data and cost trends.
  • Maintain the different models for predictive analysis to evaluate members' patterns of health care.
  • Enhance the approaches for advanced patient risk stratification based on conditions, complexity, and medication profiling.
  • Conduct cost-effectiveness analysis to identify alternate management options that provide medically necessary potentially cost-effective services.
Skills
  • Project management
  • Strong knowledge of claims/billing systems
  • Analytical & reporting skills
  • Negotiation & stakeholder management | - In-depth knowledge of healthcare billing/coding regulations
  • Experience managing provider contracts
  • Ability to lead cross-functional initiatives
  • Leadership & people management

  • Finance & Revenue Cycle Management Specialist (Saudi Arabia)

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Eram Talent Full time 120,000 - 240,000 per year

    Eram Talent is searching for a Finance & Revenue Cycle Management Specialist to join our team in Saudi Arabia. This role is essential in ensuring the effective financial management of the organization's revenue cycle processes. The specialist will be responsible for analyzing financial data, optimizing revenue streams, and ensuring compliance with financial...

  • Cluster Revenue Manager

    2 days ago

    Jeddah, Makkah Province, Saudi Arabia Elaf Group Full time

    TheCluster Revenue Managerwill be responsible for implementing the revenue management strategies and processes in the client hotels, to optimize and maximize its revenues.Key Accountabilities:Identify new revenue opportunities.Perform competitive benchmark studies and follow market trends.Create and develop pricing strategies in conjunction with the...

  • Insurance Manager

    1 week ago

    Jeddah, Makkah Province, Saudi Arabia Magrabi Health Full time $80,000 - $120,000 per year

    We're looking for aDenial Management Managerto lead and optimize denial processes, ensuring efficient reimbursement and improved revenue cycle performance.Key Responsibilities:Oversee denial management operations and analyze claim adjudication trends.Develop and implement corrective actions to reduce denial rates.Collaborate with medical, billing, and payer...

  • Sales/Business Development Representative

    1 week ago

    Jeddah, Makkah Province, Saudi Arabia Pipeline Gurus Full time

    Company DescriptionPipeline Gurus is a Managed Sales Provider dedicated to helping companies build and maintain a robust sales pipeline. By collaborating closely with sales teams, we aim to grow business within target accounts through territory or account list management. We craft personalized value propositions for each account by studying their industry,...

  • Operations Manager

    1 week ago

    Jeddah, Makkah Province, Saudi Arabia Masar Full time 90,000 - 120,000 per year

    Company DescriptionMasar is a premier addiction rehabilitation facility located in Jeddah, Saudi Arabia, dedicated to providing compassionate and transformative care. We take a holistic approach to recovery, addressing the physical, emotional, and social aspects of well-being. Recognizing that addiction impacts individuals, their families, and communities,...

  • Director of Warehouse Operations

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia ALIF Factories Full time 120,000 - 240,000 per year

    Job Title:Director of Warehouse OperationsCompany:Al Subeaei Industrial Company (ALIF)Location:Jeddah, Saudi ArabiaReports To:Chief Executive Officer (CEO)Role PurposeThe Director of Warehouse Operations will lead ALIF's end-to-end warehousing and logistics function across multiple sites. The role is responsible for designing and implementing systems,...

  • Finance Manager – Construction

    6 days ago

    Jeddah, Makkah Province, Saudi Arabia Work Gateway Full time $120,000 - $200,000 per year

    We are seeking a Finance Manager to drive financial governance and elevate our contracting business toward IPO readiness.Key Deliverables• Lead budgeting, forecasting, and cost-control across multi-site construction projects.• Oversee revenue recognition, WIP management, and IFRS-compliant project accounting.• Build audit-ready financial structures,...

  • Operations Manager

    4 days ago

    Jeddah, Makkah Province, Saudi Arabia Nadir Ali Shah HR Consultants Full time

    Job Title: Operations Manager – Ice Cream OutletsLocation:Jeddah, Saudi ArabiaDepartment:OperationsReports To:General Manager / CEOJob SummaryThe Operations Manager will oversee and manage the daily operations of multiple ice cream outlets across Jeddah. The role ensures high-quality product standards, excellent customer service, efficient store...

  • Leasing Officer

    1 week ago

    Jeddah, Makkah Province, Saudi Arabia Lifestyle Developers Full time 40,000 - 80,000 per year

    Job Summary:The Leasing Officer plays a key role in managing and executing the leasing operations of commercial properties. The position focuses on maximizing occupancy rates, securing suitable tenants, and ensuring that all leasing activities align with the company's strategic objectives and quality standards. The officer acts as a link between property...

  • Operation Team Leader Real Estate

    4 days ago

    Jeddah, Makkah Province, Saudi Arabia Mada Human Resources Management Consultations مدى الموارد البشرية للاستشارات الادارية Full time

    About the ClientThe client is a growing real estate group known for its commitment to quality, disciplined execution, and long-term value creation. With a portfolio spanning residential and commercial assets, the company continues to shape modern, community-focused developments across Saudi Arabia. It values capable talent, strong work ethics, and a hands-on...