RCM Manager

• Manage the complete revenue cycle from patient registration and eligibility verification through billing, claims processing, payment posting, denial management, and collections.
• Lead, supervise, and develop the RCM team, including billing, claims, AR, denial, and collection staff.
• Monitor daily, weekly, and monthly RCM performance and ensure achievement of operational and financial targets.
• Oversee accurate and timely submission of insurance claims.
• Monitor outstanding accounts receivable and develop strategies to reduce aging balances.
• Analyze and resolve claim denials, rejections, underpayments, and payment discrepancies.
• Identify recurring billing and coding issues and coordinate corrective actions with relevant departments.
• Maintain effective relationships with insurance companies, TPAs, and other payers.
• Review payer contracts, reimbursement terms, and payment trends to identify revenue-impacting issues.
• Ensure accurate payment posting, reconciliation, and follow-up on unpaid or partially paid claims.
• Develop and implement processes to reduce claim errors, improve clean-claim rates, and accelerate collections.
• Prepare and present RCM dashboards and management reports covering KPIs, AR aging, collections, denials, and claims performance.
• Establish team KPIs and conduct regular performance reviews.
• Coordinate with Finance and Accounting for reconciliation of collections and receivables.
• Work with Medical Coding and Clinical teams to address documentation, coding, and billing discrepancies.
• Ensure compliance with applicable healthcare regulations, payer requirements, internal policies, and data-protection standards.
• Support internal and external audits and ensure timely resolution of audit findings.
• Identify opportunities for automation, process improvement, and cost reduction within the revenue cycle.
• Escalate significant payer, operational, compliance, or revenue risks to senior management.

Desired Candidate Profile

• Bachelor's degree in Healthcare Management, Finance, Business Administration, Accounting, or a related field.
• Professional certification in RCM, medical billing, coding, or healthcare management is an advantage.
• 5–8 years of experience in healthcare revenue cycle management, including 2–3 years in a supervisory or managerial role.
• Strong knowledge of medical billing, claims processing, denial management, AR follow-up, and payer processes.
• Experience working with healthcare providers, insurance companies, and TPAs.
• Strong analytical, problem-solving, leadership, and communication skills.
• Proficiency in MS Excel and healthcare billing/RCM systems.
• Experience with dashboards, KPI reporting, and process improvement.