مدير التسويات

Job Purpose The Reconciliation Manager is responsible for overseeing and managing all reconciliation activities related to revenue, insurance claims, and payments to ensure accuracy, completeness, and compliance. The role ensures alignment between billed services, received payments, and contractual agreements with payers, while supporting financial integrity and compliance with CCHI regulations, NPHIES standards, and organizational policies. Roles and Responsibilities Organizational Accountabilities Ensure accuracy and integrity of financial and revenue reconciliation processes. Support compliance with CCHI, NPHIES, and Saudi healthcare regulations. Minimize revenue leakage and discrepancies between billing and collections. Strengthen financial controls and reconciliation governance. Support audit readiness and regulatory reporting requirements. Contribute to overall revenue cycle efficiency and financial performance. Functional Accountabilities Revenue & Payment Reconciliation Oversee reconciliation of billed services against payments received from insurance companies and patients. Ensure alignment between claims submitted, remittances, and collections. Identify and resolve discrepancies, variances, and unmatched transactions. Insurance & Payer Reconciliation (CCHI / NPHIES) Manage reconciliation of claims processed through NPHIES. Validate remittance advices and payment details against submitted claims. Ensure compliance with payer contracts, tariffs, and CCHI policies. Denials & Variance Analysis Analyze payment variances, short payments, and denied claims. Collaborate with revenue cycle teams to address root causes. Monitor trends and recommend corrective actions to reduce discrepancies. Financial Controls & Governance Establish and maintain reconciliation controls and procedures. Ensure segregation of duties and audit trails are maintained. Support internal and external audits with required documentation. Reporting & Performance Monitoring Prepare reconciliation reports, variance analysis, and financial summaries. Monitor KPIs such as reconciliation accuracy, variance rates, and recovery performance. Provide insights to management for decision-making. System & Data Management Ensure data accuracy across billing systems, HIS, and financial systems. Coordinate with IT to resolve system discrepancies or integration issues. Support automation of reconciliation processes. Stakeholder Coordination Collaborate with Finance, Revenue Cycle, HIM, and Operations teams. Liaise with insurance companies and TPAs regarding discrepancies. Support resolution of complex reconciliation issues across departments. Key Contacts Key Internal Stakeholders Commercial Department Leadership. Finance and Accounting. Revenue Cycle Management (Billing, Coding, Claims, and Collections). Health Information Management (HIM). IT and Systems Teams. Internal Audit and Compliance. Key External Stakeholders Insurance companies and Third-Party Administrators (TPAs). CCHI / NPHIES-related entities. External auditors. System vendors. Job Qualifications and Requirements Knowledge and Experience 7–10 years of experience in reconciliation, finance, or revenue cycle management. Experience within the healthcare sector or insurance environment is preferred. Strong knowledge of CCHI regulations, NPHIES workflows, and payer reconciliation processes. Experience in claims management, billing, and financial reconciliation. Strong understanding of healthcare tariffs, contracts, and reimbursement models. Experience with ERP systems and healthcare billing systems. Education and Certifications Bachelor’s degree in Finance, Accounting, Health Administration, or a related field. CPA / CMA / SOCPA certification (Preferred). Certified Revenue Cycle or Healthcare Finance certifications (Preferred). Training in CCHI / NPHIES processes (Preferred). IFRS or financial reporting certifications (Preferred).