About the Role
Responsible for the effective management and quality of critical HIS master data supporting RCM operations, including pricing, packages, insurance plans, and policy masters. The role also supports RCM system and process improvements, identifying operational gaps, system inefficiencies, and opportunities for automation or digitalization.
The role acts as a key interface between RCM, IT/HIS, Finance, Contracts & Pricing, and operational teams, translating business requirements into accurate system configurations, process enhancements, and practical digital solutions that improve billing accuracy, operational efficiency, and revenue capture.
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Responsibilities
Key Responsibilities
1. HIS Master Data Management
- Manage and maintain critical HIS master data required for accurate RCM billing and revenue capture.
- Maintain pricing masters, including tariffs, rate plans, effective dates, payer-specific pricing, and related configurations.
- Maintain package masters, including package components, pricing, validity, and payer/plan applicability.
- Manage Insurance Plan / Policy Masters, including insurer, plan, network, and rate-plan mappings.
- Ensure timely and accurate implementation of approved pricing, contractual, payer, and regulatory changes within HIS.
- Perform detailed validation and QC of master-data updates before and after implementation.
- Ensure appropriate documentation, approvals, and audit trails are maintained for master-data changes.
- Identify and resolve incorrect mappings, duplicate masters, configuration inconsistencies, and other data-quality issues.
2. HIS System & Process Improvements
- Proactively identify system and process gaps within the RCM billing lifecycle and assess their operational and financial impact.
- Review existing workflows, system configurations, and business processes to identify opportunities to improve efficiency, controls, and billing accuracy.
- Work with RCM stakeholders and IT/HIS teams to define and implement system enhancements addressing identified gaps.
- Translate operational requirements into business requirements, functional specifications, and system/process improvement opportunities.
- Evaluate opportunities to introduce system controls, validations, alerts, workflow changes, and automated checks to prevent errors at source.
- Participate in solution design, testing, UAT, and implementation of system and process enhancements.
- Monitor implemented changes to ensure the intended business outcome is achieved and identify any downstream impacts.
- Maintain a structured log of system/process improvement opportunities, prioritizing initiatives based on business impact, risk, effort, and revenue implications.
3. Digital Solutions & Automation
- Identify manual, repetitive, and error-prone RCM activities that can be improved through automation, digital tools, or workflow solutions.
- Work with IT and relevant stakeholders to test and operationalize solutions.
- Assess the effectiveness of implemented solutions through measurable improvements in accuracy, turnaround time, manual effort, and process control.
- Continuously identify opportunities to simplify and digitize RCM processes.
4. Master Data Quality & System Controls
- Establish and perform appropriate maker-checker and QC controls for critical HIS master-data updates.
- Conduct periodic audits of pricing, package, and insurance master data.
- Validate effective dates, pricing logic, payer mappings, and other critical parameters against approved source documents.
- Analyse billing issues linked to incorrect system configuration and perform root-cause analysis.
- Recommend system or process controls to prevent recurring errors.
- Ensure master-data standards and system configurations are consistently applied across facilities and business units.
5. RCM Analytics & Operational Insights
- Analyse RCM operational data to identify billing trends, anomalies, process gaps, and potential revenue leakage.
- Develop and maintain operational reports and dashboards supporting RCM performance monitoring.
- Analyse the impact of pricing, system, and process changes on billing outcomes.
- Provide data-driven insights to support prioritization of system enhancements and process improvements.
- Support RCM management with analysis of operational issues and improvement opportunities.
Qualifications
- [Qualifications details not provided in the source material]
