Project Leader

The Project Leader – RCM Medical Billing is responsible for overseeing end-to-end revenue cycle operations for assigned client accounts or business units. This role drives project execution, team performance, client satisfaction, and process excellence across all billing functions — from charge capture to final collections. The ideal candidate brings deep RCM domain expertise combined with strong leadership and project management capabilities.

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