Finance & Revenue Cycle Management (RCM) Specialist (Saudi Arabia)

The KH Finance & Revenue Cycle Management (RCM) Specialist is responsible for overseeing the financial operations and revenue cycle management of KAUST Health, ensuring accurate financial reporting, effective budget management, and efficient insurance claims processing. The role focuses on validating invoices and quotations, managing end-to-end insurance claim activities, monitoring financial performance, and optimizing revenue collection while ensuring compliance with contractual agreements and healthcare regulations. Working closely with healthcare operators, insurance providers, finance teams, and senior leadership, the specialist plays a key role in improving financial sustainability, minimizing claim denials, strengthening financial controls, and supporting strategic decision-making through data-driven financial analysis and reporting.

Key Responsibilities

1. Review and validate invoices submitted by the healthcare operator to ensure accuracy, completeness, and compliance with contractual agreements before payment approval.
2. Evaluate and approve quotations for healthcare services by verifying pricing, scope, and alignment with agreed contracts and organizational policies.
3. Lead the annual budgeting process, including budget preparation, monitoring, forecasting, and expenditure control to support KAUST Health's financial objectives.
4. Prepare financial reports and conduct variance analysis, providing monthly financial insights, forecasting, and recommendations to improve operational and financial performance.
5. Manage the end-to-end Revenue Cycle Management (RCM) process, ensuring timely and accurate submission of insurance claims to all insurance providers.
6. Validate insurance claims by reviewing billing accuracy, medical coding, documentation, and compliance with payer requirements to minimize claim denials.
7. Monitor claim rejections, collections, and reimbursement performance, analyze denial trends, implement corrective actions, and improve cash flow and revenue recovery.
8. Lead reconciliation meetings with healthcare operators and insurance companies to resolve payment discrepancies, outstanding claims, billing issues, and account reconciliations.
9. Develop and present financial and revenue cycle KPIs to senior leadership, identifying financial risks, revenue optimization opportunities, and process improvement initiatives.
10. Ensure financial compliance and stakeholder collaboration by supporting internal and external audits, maintaining compliance with financial policies and healthcare regulations, and serving as the primary liaison between KAUST Health, Finance, healthcare operators, and insurance companies.

Requirements

1. Bachelor's degree in Finance, Accounting, Business Administration, or a related discipline (Finance or Accounting preferred).
2. Master's degree in Finance, Accounting, Business Administration, or Healthcare Management is preferred.
3. Professional certification such as CPA, CMA, ACCA, or equivalent is considered an added advantage.
4. Minimum of 6 years of professional experience, including at least 3 years in a leadership or specialist role in finance, healthcare finance, or revenue cycle management.
5. Proven experience in healthcare finance, including budgeting, financial planning, financial reporting, cost control, and expenditure management within hospitals or healthcare organizations.
6. Extensive knowledge of Revenue Cycle Management (RCM), including insurance claims processing, claim validation, reimbursement, denial management, collections, and financial reconciliation.
7. Strong financial analysis and reporting skills, with experience in budget preparation, forecasting, variance analysis, KPI reporting, and financial performance management.
8. Advanced Microsoft Excel proficiency, including Pivot Tables, XLOOKUP/VLOOKUP, financial modeling, dashboards, data analysis, and reporting; experience with ERP or healthcare financial systems is highly desirable.