Job Description

PHCC has a vision to be the leader in transforming the health and wellbeing of people’s lives in Qatar. PHCC’s mission is to deliver comprehensive, integrated and coordinated person-centered health care services in the community through focusing on disease prevention, healthy lifestyles, and wellness. In partnership with our stakeholders, we will improve the health and wellbeing of our population.

The incumbent is primarily responsible in ensuring accurate and efficient revenue cycle management process in PHCC Health Center. The position holder serves as the functional authority for end‑to‑end claim lifecycle and payer rules, translating policy and clinical workflows into robust processes and system configurations within EMR/RCM platforms.

Key Accountabilities & Duties:

• Own the RCM operating framework across Patient Access, Charge Capture, Coding/HIM, Claims & Denials, Cash Posting/AR, and Self-pay/Collections.
• Map out the end-to-end revenue cycle processes across all applicable directorates of PHCC
• Define and maintain RCM policies/SOPs, internal controls, and role clarity (RACI)
• Lead RCM system configuration: fee schedule loads, claim edits, charge routers, work queues, and clearinghouse optimization.
• Optimize EMR/RCM system configuration, insurance datasets, and workflow integration with HICT.
• Provide subject expertise and guidance to IT developers during the software development life cycle.
• Lead cross-functional RCM projects under the responsibility of Finance directorate
• Build project charters, timelines, RAID logs, and stakeholder communications; manage scope, resources, risks, and benefits realization.
• Coordinate user acceptance testing (UAT), cutover, and stabilization for system/process changes within Finance directorate.
• Provide functional reporting to NHI program and Finance leadership team on all projects undertaken by Finance directorate.
• Conduct training for front-line teams on RCM processes, documentation standards, and payer requirements.
• Should assist National Health Insurance Project Managers in developing and implementing RCM solutions across all applicable directorates of PHCC.
• Collaborate with Finance, HICT, Operations, and payers to improve claim rates and reduce denials of claims..
• Serve as the point of contact between clinical operations, RCM teams, payers/TPAs, and IT for issue escalation and resolution.
• Collaborate with Coding/HIM to enforce ICD-10-CM, CPT/HCPCS and coding standards implementation in line with regulatory and payor guidelines.
• Operationalize contract terms into system builds (payer/plan IDs, fee schedules), authorization matrices, and edits alongside payor contracting and management team.
• Monitor processes as directed to identify program vulnerabilities and ensure compliance with Health Insurance Payers agreements/contracts and all statutory, regulatory, and sub-regulatory requirements are met.
• Ability to clearly communicate and exchange information with co-workers, teammates, stakeholders, and other personnel, as required
• Demonstrate proactive approach to patient safety by thinking what might go wrong in all your undertakings and take necessary measures to prevent them from happening.
• Identify and report potential or actual patient safety concerns, errors and/or near misses in timely manner.
• Partner with line manager to understand risks in your area of work, develop a plan on how to mitigate those risks, and develop shared accountability for implementing and evaluating the plan.
• The incumbent will undertake any such related duties or responsibilities as directed.
• Working within PHCC may give access to knowledge of confidential matters which may include personal information of staff & Patients.
• Such information must be considered strictly confidential and must not be discussed or disclosed.

Education Requirements: Bachelor’s degree in business administration, Finance or management or a related stream.

Certification, license or training Requirements (MANDATORY): CRCR (HFMA), CHFP, CPC/COC/CPB (AAPC), CCS/CCS-P (AHIMA), or equivalent revenue cycle/coding credential

Experience & Knowledge: 7+ years RCM experience; strong background in coding, claims, and insurance operations. Experience with EMR/RCM systems, UAT, and requirements analysis.