Assistant Manager RCM | US Helathcare

The Assistant Manager RCM (AR) is responsible for leading the Accounts Receivable (AR) and Denial Management functions to maximize reimbursement, reduce aging receivables, and improve cash flow. The role involves managing high-performing teams, driving operational excellence, ensuring timely resolution of denied and underpaid claims, and collaborating with internal and external stakeholders to optimize revenue cycle performance. The ideal candidate possesses strong expertise in US healthcare payer processes, denial analytics, and AR operations, along with proven leadership and people management skills.

Key Responsibilities

• Lead and oversee day-to-day AR Follow-up and Denial Management operations across multiple payer groups and specialties.
• Manage team performance to ensure achievement of productivity, quality, collections, and service level agreement (SLA) targets.
• Monitor AR aging, denial inventory, unresolved claims, and payer trends to prioritize work queues and maximize collections.
• Analyze denial patterns, identify root causes, and implement corrective and preventive actions to reduce recurring denials.
• Drive timely resolution of denied, rejected, underpaid, and appealed claims while minimizing write-offs.
• Review payer correspondence, remittance advice (ERA/EOB), and reimbursement trends to identify opportunities for revenue recovery.
• Collaborate with Coding, Charge Entry, Billing, Payment Posting, Credentialing, Provider Enrollment, and Client teams to resolve revenue cycle issues.
• Develop and maintain denial management strategies, escalation matrices, and payer-specific workflows.
• Conduct quality audits and provide coaching, mentoring, and performance feedback to team members.
• Prepare and present operational reports, dashboards, and key performance metrics to leadership and clients.
• Ensure compliance with HIPAA, CMS regulations, payer policies, and client-specific requirements.
• Support client calls, business reviews, transition activities, and process improvement initiatives.
• Lead workforce planning, resource allocation, hiring, onboarding, and employee development.
• Drive automation and continuous improvement initiatives to enhance operational efficiency and financial outcomes.

Qualifications

• Bachelor's degree
• 10+years of experience in US Healthcare Revenue Cycle Management.
• Minimum 5 years of experience leading AR Follow-up and Denial Management teams.
• CPC, CCS, CRCR, or other relevant healthcare certifications are preferred.

Required Experience

• Strong expertise in US healthcare AR Follow-up and Denial Management.
• Hands-on experience managing Commercial, Medicare, Medicaid, Managed Care, and Workers' Compensation payers.
• Experience handling appeals, reconsiderations, payer escalations, and underpayment recovery.
• Strong understanding of denial codes (CARC/RARC), EOBs, ERAs, and payer reimbursement guidelines.
• Experience with practice management systems, EMRs/EHRs, and clearinghouse applications.
• Ability to interpret payer contracts and reimbursement methodologies.
• Experience supporting multiple specialties and provider groups is preferred.

Required Skills

• Strong leadership, team management, and coaching skills.
• Excellent analytical and problem-solving capabilities.
• Expertise in denial trend analysis and revenue recovery strategies.
• Advanced proficiency in Microsoft Excel, reporting, and performance dashboards.
• Strong communication, client management, and stakeholder engagement skills.
• Ability to prioritize work in a fast-paced, deadline-driven environment.
• Knowledge of Lean, Six Sigma, or continuous improvement methodologies is an advantage.