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.

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.