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.

Responsibilities

• 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.

Qualifications

• Bachelors 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.