RCM Operations Manager

CF Outsourcing Solutions; Quezon City; On-site; PHP 1,400,000 - 2,200,000; Full time

Job summary

CF Outsourcing Solutions is seeking an experienced RCM Operations Manager to lead end-to-end revenue cycle management, drive operational excellence, and ensure key performance metrics are met.

You will oversee large teams, optimize processes, ensure HIPAA compliance, collaborate with clients and payers, and report insights to senior leadership. This role requires a bachelor's degree and 5+ years in RCM leadership.

Qualifications

• Bachelor's degree required in a related field.
• 5+ years of leadership experience in Revenue Cycle Management.
• Strong knowledge of insurance verification, prior authorization, medical billing, claims processing, A/R management, denial management, and payment posting.
• Experience managing large operational teams in healthcare/RCM.
• Advanced Excel and data analysis skills.
• CPC/CPB/CRCR or related healthcare certifications preferred.

Responsibilities

• Oversee daily operations of the RCM department.
• Lead and develop RCM supervisors, team leads, and staff.
• Monitor KPIs: clean claim rate, first-pass resolution, days in A/R, denial rate, collection rate, authorization turnaround times.
• Identify bottlenecks and implement process improvements.
• Develop strategies to maximize reimbursement and reduce denials.
• Collaborate with clients, providers, payers, and cross-functional teams to resolve escalated issues.
• Ensure HIPAA compliance and payer regulations.
• Analyze operational reports and present insights to senior leadership.
• Support workforce planning, forecasting, and resource allocation.
• Lead training, coaching, and performance management initiatives.

Skills

Leadership experience

KPI analysis

Stakeholder management

Communication skills

Data analysis

Healthcare domain knowledge

Process improvement

Education

Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field

Tools

EMR/EHR platforms

Reporting tools

Microsoft Excel (advanced)

Job description

About the role

We are seeking an experienced and results-driven RCM Operations Manager to lead and optimize our Revenue Cycle Management operations. The ideal candidate will oversee end-to-end RCM functions, drive operational excellence, ensure key performance metrics are met, and lead high-performing teams responsible for maximizing revenue collection and maintaining compliance with healthcare regulations.

Key responsibilities

• Manage daily operations of the Revenue Cycle Management department
• Lead and develop RCM supervisors, team leads, and staff to achieve operational goals
• Monitor and improve key performance indicators (KPIs), including clean claim rate, first-pass resolution rate, days in A/R, denial rate, collection rate, and authorization turnaround times
• Identify operational bottlenecks and implement process improvements
• Develop strategies to maximize reimbursement and reduce claim denials
• Collaborate with clients, providers, payers, and cross-functional teams to resolve escalated revenue cycle issues
• Ensure compliance with HIPAA, payer regulations, and company policies
• Analyze operational reports and present insights and recommendations to senior leadership
• Support workforce planning, forecasting, and resource allocation
• Lead training, coaching, and performance management initiatives

About you

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field
• Minimum of 5 years of leadership experience in Revenue Cycle Management
• Strong knowledge of insurance verification, prior authorization, medical billing, claims processing, accounts receivable management, denial management, and payment posting
• Experience managing large operational teams in a healthcare or RCM environment
• Strong analytical and reporting skills
• Excellent communication and stakeholder management abilities
• Proficiency in healthcare practice management systems, EMR/EHR platforms, and reporting tools
• Advanced Microsoft Excel and data analysis skills
• Preferred: CPC, CPB, CRCR, or other relevant healthcare certifications