Job Summary
As a Manager in RCM, you will lead and develop a team within the Revenue Cycle Management (RCM) domain, focusing on achieving seamless operations across all verticals. You will be responsible for process-specific KRA/KPIs, efficient AR optimization, and client satisfaction. The role requires an in-depth understanding of the end-to-end RCM process, US healthcare regulations, insurance policies, and coding guidelines, along with a strong track record in team management and client interaction.
Key Responsibilities
- Oversee all verticals of RCM, ensuring consistent performance across Charge Entry, Payment Posting, Denial Management, AR follow-up, and Patient Calling.
- Lead employee training, develop plans for growth, and manage performance evaluations.
- Minimize staff attrition, foster team engagement, and optimize resource utilization.
- Establish and monitor team performance metrics, ensuring adherence to productivity, quality, and timeliness goals.
- Conduct regular training sessions, keep the team updated on guidelines and industry changes, and mentor team members.
- Set clear targets for team leads and associates to meet production and quality objectives.
- Ensure TAT compliance, maintain process documentation, and timely client communication.
- Schedule resources based on client needs, adjusting to meet Service Level Agreements (SLAs).
- Regularly assess service levels and implement strategies to enhance service delivery.
- Conduct monthly, quarterly, and annual assessments and provide ongoing feedback.
- Maintain records of client updates and communicate key insights to the team.
- Approve employee time records and manage time-off requests.
- Lead weekly and monthly business reviews with clients, provide weekly reporting, and establish effective communication channels.
Mandatory Skills
- US Healthcare Experience: Proficiency in AR calling, Denial Management, Payment Posting, Charge Entry, Credit Balance, and Authorization.
- Medical Billing Expertise: Strong knowledge of medical billing, demographics, coding, insurance benefits, and appeal processes.
- Operations & Team Management: Proven track record in managing and developing high-performing teams.
- Communication & Presentation: Excellent business communication, presentation, and interpersonal skills.
- Problem-Solving: Independent thinker with strong analytical skills and problem-solving ability.
- Client Management: Strong ability to maintain customer and internal relationships, manage performance reviews, and onboard new RCM clients.
- System Proficiency: High-level proficiency in various EMR/EHR systems, practice management software, and Microsoft Office Suite. Strong knowledge with multiple billing software.
- Performance Monitoring: Expertise in setting KPIs and analyzing performance data to enhance team output and account performance.
- Process Improvement: Knowledge of Lean, Six Sigma, or similar methodologies.
- Large-Scale RCM Experience: Previous experience in large RCM firms is advantageous.