Revenue Cycle Services - Manager, Healthcare

Revenue Cycle Services Manager

Role & responsibilities

• Manage full scope of RCM operations, including billing, denials, collections, AR management, and reporting.
• Collaborate with clients to define goals, resolve escalations, and improve service delivery.
• Track and report productivity metrics, TAT, AR aging, and denial trends on a regular basis.
• Lead and coach large teams (including TLs and AR specialists), ensuring alignment with SLA and performance targets.
• Conduct weekly/monthly/quarterly client business reviews (WBR/MBR/QBR) with actionable insights.
• Drive hiring decisions, attrition control, team development, and succession planning.

Operational Oversight & Client Service:

• Oversee and coordinate with offshore billing partners for IRF & LTACH claims submission and follow-up.
• Monitor Discharge Not Billed (DNB) queues and collaborate with clients for timely resolution.
• Review payer contracts and escalate discrepancies in payments, rates, and allowances.
• Ensure AR and denial follow-ups are timely and accurate, adhering to payer and industry guidelines.
• Track and resolve issues in interface eligibility, claims submission, and remittance advice processes.
• Coordinate daily client communications and respond to inquiries with high professionalism.
  

Claims & Billing Quality Control:

• Ensure claims are scrubbed and billed accurately by the billing partner.
• Address clearinghouse rejections and escalate unresolved issues.
• Review billing logs, rejection trends, and cash logs for accuracy and reconciliation.
• Access portals (Medicare, Medicaid, payer-specific) to review EOBs, RTPs, COBs, and claim statuses.
• Review credit balances and bad debts, including Medicare reporting.
  

Process Improvement & Governance:

• Participate in regular RCM review meetings and escalate negative performance trends.
• Coordinate RCM meetings with clients and internal stakeholders.
• Support clearinghouse enrollments and lockbox access as needed.
• Ensure compliance with client SLAs, industry regulations, and internal policies.

Baseline Competencies:

• Attention to Productivity and Quality
• Strong Customer Service Orientation
• Critical Thinking and Problem Solving
• Effective Communication Skills (Written and Verbal)

Job Competencies:

• Proficient in Microsoft Office Suite (Word, Excel, Outlook)
• Sound knowledge of healthcare claims processing, AR follow-up, and collections
• Strong understanding of IRF & LTACH billing workflows and payer guidelines
• Comfortable with EMR systems, clearinghouses, and portal-based workflows

Preferred candidate profile

• IRF & LTACH domain expertise
• Medical Billing Certification (AHIMA/AAPC or equivalent)
• Experience working with US healthcare clients or offshore delivery models
• Exposure to metric-based performance tracking and reporting