Key Responsibilities
- Manage and oversee the end-to-end US Healthcare RCM process, including patient registration, eligibility, charge entry, coding coordination, claim submission, payment posting, denial management, AR follow-up, and collections.
- Lead, mentor, and manage a team of medical billing and RCM professionals.
- Monitor team performance, productivity, quality, and key operational metrics.
- Develop strategies to improve collections, reduce AR days, and minimize claim denials.
- Analyze aging reports, denial trends, and outstanding accounts and take corrective actions.
- Ensure claims are submitted accurately and within payer timelines.
- Handle escalations related to billing, denials, insurance payments, and accounts receivable.
- Ensure compliance with US healthcare billing practices, payer guidelines, and applicable regulations.
- Coordinate with internal teams and clients to resolve billing and RCM-related issues.
- Prepare and present operational reports, dashboards, and performance metrics to management.
- Identify process gaps and implement continuous improvement initiatives.
Required Skills & Qualifications
- 1015 years of experience in US Healthcare Medical Billing/RCM.
- Must have strong end-to-end RCM expertise.
- Must have proven team handling/people management experience.
- Strong knowledge of the complete US Healthcare billing cycle.
- Expertise in AR Management, Denial Management, Claims Processing, Payment Posting, and Collections.
- Strong understanding of US insurance payers, Medicare, Medicaid, and commercial insurance.
- Excellent analytical, problem-solving, communication, and leadership skills.
- Ability to work independently and manage operations in a fast-paced environment.
- Must be comfortable working from 05:30 PM to 03:00 AM.
Preferred Profile
Candidates with experience managing large RCM operations and achieving measurable improvements in collections, denial rates, AR aging, and team productivity will be preferred.