Key Responsibilities:
Project & Operations Management
- Own the day-to-day management of RCM billing projects including charge entry, claims submission, payment posting, denial management, AR follow-up, and patient billing
- Define project scope, timelines, milestones, and deliverables in alignment with client SLAs and internal KPIs
- Monitor project health through regular reporting, dashboards, and operational reviews
- Manage project risks, escalations, and issue resolution proactively
- Coordinate onshore and offshore teams to ensure seamless workflow execution
Client Management
- Serve as the primary point of contact for assigned client accounts
- Conduct regular client calls, business reviews, and performance updates
- Understand client-specific billing requirements, payer mix, and specialty workflows
- Drive client retention and satisfaction by consistently meeting or exceeding SLA targets
- Manage contract scope changes, new implementations, and client transitions
Team Leadership
- Lead, mentor, and manage a team of billing specialists, AR callers, coders, and team leads
- Set clear performance expectations, conduct appraisals, and drive accountability
- Partner with HR and Training to support onboarding, ramp-up, and upskilling initiatives
- Foster a high-performance culture focused on quality, compliance, and continuous improvement
Financial & Revenue Performance
- Track and improve key RCM metrics — Clean Claim Rate, First Pass Resolution Rate, Denial Rate, Days in AR, Collection Rate, and Net Collection Ratio
- Identify revenue leakage points and implement corrective action plans
- Review aging buckets and drive resolution of high-value and aged AR
- Provide monthly financial performance reports to leadership and clients
Process Improvement & Compliance
- Identify process gaps and lead initiatives to streamline billing workflows
- Ensure adherence to HIPAA, CMS, OIG, and payer-specific compliance standards
- Implement and document SOPs, workflow guidelines, and escalation matrices
- Drive adoption of automation tools and technology enhancements in billing processes
Reporting & Analytics
- Publish weekly/monthly operational dashboards and KPI scorecards
- Analyze denial trends, underpayments, and payer behavior to recommend strategic actions
- Present insights and recommendations to senior leadership and client stakeholders
Required Qualifications:
- Bachelor's degree in Healthcare Administration, Business, Finance, or related field
- 6–9 years of experience in US Healthcare RCM / Medical Billing
- Minimum 2–3 years in a project leadership, operations lead, or account management role
- Strong working knowledge of physician billing, hospital billing, or multi-specialty RCM
- Hands-on experience with billing platforms such as Epic, Athenahealth, eClinicalWorks, Kareo, Advanced MD, or Meditech
- Solid understanding of CPT, ICD-10, HCPCS coding, EOB/ERA reading, and payer guidelines
Preferred Qualifications:
- PMP, Six Sigma (Green/Black Belt), or equivalent project management certification
- CPC, CPMA, or CRC certification (AAPC/AHIMA)
- Experience managing offshore/nearshore RCM delivery teams
- Familiarity with RPA tools, AI-driven billing platforms, or RCM analytics software
Skills & Competencies:
- Strong leadership and people management capabilities
- Excellent client-facing communication and presentation skills
- Data-driven decision-making with advanced analytical ability
- Proficiency in MS Excel, PowerPoint, and BI/reporting tools
- Ability to manage multiple projects and priorities simultaneously
- Deep understanding of US payer landscape — Medicare, Medicaid, commercial, and managed care
- Strong problem-solving, conflict resolution, and negotiation skills