The RCM Operating Lead is responsible for overseeing the day-to-day operations of the Revenue Cycle Management team, ensuring optimal performance in medical billing, AR follow-up, denial management, and reimbursement processes. The candidate must have extensive expertise in Denial Management, Medicare, Medicaid, Assisted Living Facility (ALF), Skilled Nursing Facility (SNF), and Physician Practice AR follow-up. This role requires strong analytical skills, payer knowledge, and the ability to drive collections while reducing aging AR.This role drives operational efficiency, team productivity, and compliance with payer and regulatory guidelines. The ideal candidate will have strong leadership, analytical, and process improvement skills within a healthcare billing environment.
Key Responsibilities:
- Lead, manage, and optimize all operational functions within the RCM cycle including billing, coding, collections, denials, and payment posting.
- 7+ years of Healthcare AR Follow-Up and Denial Management experience.
- Mandatory experience handling Medicare, Medicaid, and Managed Care plans.
- Mandatory experience with ALF, SNF, Long-Term Care, or Provider Practice billing.
- Proven ability to independently manage AR accounts and collections.
- Strong knowledge of appeals, reconsiderations, timely filing, and payer policies.
- Experience working with insurance portals and EHR/PM systems.
- Excellent communication and problem-solving skills.
- Monitor and analyze key performance indicators (KPIs) such as DSO, denial rates, clean claim rate, and collection effectiveness.
- Implement process improvements to enhance revenue capture and reduce claim denials and rejections.
- Coordinate with cross-functional teams (e.g., coding, credentialing, clinical, compliance) to resolve RCM-related issues.
- Develop and manage daily/weekly production targets and quality standards for AR callers, billers, and analysts.
- Provide guidance and mentorship to team leads and staff, fostering a culture of accountability and continuous improvement.
- Ensure compliance with HIPAA, payer policies, and federal/state regulations.
- Collaborate with clients (in a BPO or third-party RCM setting) to review performance, address escalations, and implement corrective actions.
- Lead training initiatives for new hires and ongoing education for team members.
- Prepare and present operational reports to senior leadership.
Required Qualifications:
- Bachelor's degree or a related field (or equivalent experience).
- Minimum of 5 years in Revenue Cycle Management with at least 2 years in a leadership role and AR caller experience.
- Strong understanding of US healthcare payers, billing workflows, denials, and reimbursement mechanisms.
- Proficiency with RCM platforms (e.g., AdvancedMD, eClinicalWorks, Epic, or similar).
- Excellent communication, organizational, and team management skills.
- Ability to thrive in a fast-paced, performance-driven environment.
Job Type: Full-time
Pay: ₹45,000.00 - ₹55,000.00 per month
Work Location: In person
