RCM Expert & Lead (Healthcare Program)

Eastvantage; Pasig; On-site; PHP 1,200,000 - 1,800,000; Full time

Job summary

Eastvantage is seeking an experienced RCM Expert & Lead to manage a healthcare revenue cycle team focused on US-based medical billing, collections, and posting. The role emphasizes leadership, process control, and continuous improvement to meet client KPIs.

You will drive performance, ensure HIPAA compliance, coordinate with clients, and mentor staff using Power BI and Excel dashboards. The position requires 5–7 years in US RCM with 1–2 years in supervision and willingness to work US shifts if

Qualifications

• 5–7 years of US healthcare revenue cycle operations experience.
• 1–2 years in a team lead or supervisory role.
• Strong knowledge of medical billing, denial management, and collections.
• Proficient with CPT/ICD-10 codes and payer rules (Medicaid/Medicare).
• Experience with HIPAA and compliance guidelines.
• Experience using EMR/EHR platforms and clearinghouses.

Responsibilities

• Lead, mentor, and manage a team handling billing, collections, and posting.
• Oversee daily operations for timely, accurate, compliant RCM processes.
• Be the client liaison for delivery updates, escalations, and issue resolution.
• Monitor workload, track productivity, and optimize performance.
• Ensure adherence to HIPAA and company policies.
• Track and report on SLAs and KPIs, including denial rates and days in A/R.
• Conduct performance reviews and share insights with stakeholders.
• Drive client satisfaction through proactive reporting and issue resolution.
• Audit denials and billing errors; drive root-cause analyses for improvements.
• Utilize Power BI and Excel dashboards to identify trends and improvements.
• Lead workflow improvements and automation of repetitive tasks.
• Facilitate knowledge sharing and upskilling sessions.

Skills

RCM expertise

HIPAA compliance

Billing & denial management

Excel (VLOOKUP, Pivot)

Power BI exposure

Stakeholder management

Communication skills

Problem-solving

Team leadership

CPT/ICD-10 knowledge

Education

Bachelor’s degree in healthcare administration, Accounting, or related field

Tools

EMR software

EHR systems

Clearinghouses

Job description

We are looking for an experienced RCM Expert & Lead (Healthcare Program) to join our dynamic team in the healthcare industry. The ideal candidate will be responsible for day‑to‑day team management, performance monitoring, client delivery, KPI adherence, and continuous improvement of the revenue cycle operations, including medical billing, collections, and payment posting. This role requires hands‑on experience in US healthcare RCM processes, excellent analytical and leadership skills, and a commitment to delivering operational excellence and value to the client.

Location: Pasig, Philippines

Work Mode: Work from Office

Role: RCM Expert & Lead (Medical Billing & AR - Healthcare Industry)

What You'll Do

• Lead, mentor, and manage a team of RCM specialists handling billing, collections, and payment posting activities.
• Oversee daily operations to ensure timely, accurate, and compliant execution of RCM processes.
• Act as the single point of contact for the client for delivery updates, escalations, and issue resolution.
• Monitor workload distribution, track productivity, and optimize team performance.
• Ensure adherence to HIPAA compliance and company policies.
• Track and report on agreed SLAs and KPIs, including denial resolution rate, days in A/R, payment posting accuracy, and claim rejection rates.
• Conduct weekly/monthly performance reviews and share insights with internal and client stakeholders.
• Drive client satisfaction through proactive communication, timely reporting, and issue resolution.
• Conduct regular audits and root‑cause analyses for denials, underpayments, and billing errors.
• Leverage reporting tools (Power BI, Excel dashboards, etc.) to identify trends and improvement opportunities.
• Lead initiatives to streamline workflows, enhance process compliance, and automate repetitive tasks where applicable.
• Facilitate knowledge sharing sessions, process training, and upskilling programs for the teams.

What We're Looking For

• Minimum of 5-7 years of experience in US healthcare revenue cycle operations, with at least 1–2 years in a team lead or supervisory role.
• Strong understanding of medical billing, denial management, collections, payment posting, and related compliance guidelines (e.g., HIPAA).
• Proficient in billing and EMR software, including familiarity with EOBs, ERAs, UB04, and HCFA 1500 forms.
• Knowledge of payer‑specific rules and processes, including Medicaid, Medicare Advantage, VA, and Workers' Compensation.
• Solid experience in using healthcare billing codes (CPT, ICD‑10).
• Demonstrated success in improving A/R performance and reducing denials.
• Proficiency in MS Office tools, particularly Excel (VLOOKUP, Pivot Tables, etc.); Power BI exposure is a plus.
• Excellent communication, stakeholder management, and problem‑solving skills.
• Bachelor’s degree in healthcare administration, Accounting, or a related field.
• Experience working in a BPO or offshore environment.
• Exposure to Electronic Health Record (EHR) systems and clearinghouses.
• Ability to work US shifts, if required, to ensure alignment with client time zones.