Revenue Cycle Management SME | AR & Denials Specialist

Optum, a UnitedHealth Group Company; Muntinlupa; On-site; PHP 300,000 - 550,000; Full time

Job summary

Optum is seeking a Revenue Cycle Management (RCM) Training SME to design and deliver onboarding, refresher, and upskilling programs for RCM teams in the Philippines. You will partner with Operations, Quality, and SMEs to align content with client requirements and compliance standards.

You will coach and mentor learners, evaluate training effectiveness, and support transitions to new workflows, ensuring high productivity and quality across AR Follow-Up, Claims Processing, Denial Management,

Qualifications

• Bachelor's degree or equivalent work experience.
• Minimum of 1 year of experience in Healthcare Revenue Cycle Management (RCM).
• Experience in AR Follow-Up, Denial Management, Claims Processing, Medical Billing, Collections, and Appeals.
• Experience as SME/Team Lead/Quality Analyst/Quality Auditor/Acting Trainer/Coach is highly preferred.
• Experience within a healthcare BPO or revenue cycle operations environment preferred.

Responsibilities

• Facilitate new hire, refresher, and upskilling training programs for RCM teams.
• Deliver training on AR Follow-Up, Claims Processing, Denial Management, Appeals, and related RCM processes.
• Conduct coaching sessions and provide performance support to help employees improve productivity and quality.
• Develop and update training materials, job aids, and process documentation.
• Partner with Operations, Quality, and SMEs to identify knowledge gaps and recommend learning solutions.
• Monitor trainee progress and evaluate training effectiveness through assessments and feedback.
• Support process transitions, updates, and implementation of new workflows.
• Ensure training content aligns with client requirements, compliance standards, and operational expectations.

Skills

Facilitation

Presentation skills

Verbal and written communication

Coaching and mentoring

Analytical skills

Process improvement

Stakeholder management

MS Office (Excel/PowerPoint)

Education

Bachelor's degree or equivalent

Tools

MS Office

Excel

PowerPoint

Job description

Position Summary

The RCM SME is responsible for delivering training programs that equip employees with the knowledge and skills required to perform Revenue Cycle Management (RCM) processes effectively. This role will support new hire onboarding, refresher training, process updates, and performance improvement initiatives while ensuring alignment with business goals and client requirements.

Key Responsibilities

• Facilitate new hire, refresher, and upskilling training programs for RCM teams.

• Deliver training on AR Follow-Up, Claims Processing, Denial Management, Appeals, and related RCM processes.

• Conduct coaching sessions and provide performance support to help employees improve productivity and quality.

• Develop and update training materials, job aids, and process documentation.

• Partner with Operations, Quality, and SMEs to identify knowledge gaps and recommend learning solutions.

• Monitor trainee progress and evaluate training effectiveness through assessments and feedback.

• Support process transitions, updates, and implementation of new workflows.

• Ensure training content aligns with client requirements, compliance standards, and operational expectations.

Required Qualifications

• Bachelor's degree or equivalent work experience.

• Minimum of 1 year of experience in Healthcare Revenue Cycle Management (RCM).

• Strong experience in one or more of the following:

  • AR Follow-Up

  • Denial Management

  • Claims Processing

  • Medical Billing

  • Collections

  • Appeals and Resolution Management

• Experience as an SME, Team Lead, Quality Analyst, Quality Auditor, Acting Trainer, Coach, or Process Trainer is highly preferred.

• Experience within a healthcare BPO or revenue cycle operations environment preferred.

Preferred Skills

• Strong facilitation and presentation skills.

• Excellent verbal and written communication skills.

• Coaching and mentoring abilities.

• Analytical and problem-solving skills.

• Process improvement mindset.

• Stakeholder management and collaboration skills.

• Proficiency in MS Office applications, particularly Excel and PowerPoint.

Ideal Candidate Profile

The ideal candidate has a strong RCM operations background and has demonstrated experience coaching, mentoring, supporting new hires, or leading process-related initiatives. Formal training experience is preferred but not required, as candidates with SME, Quality, or Team Lead experience may also be successful in this role.