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.

- 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.