Head - Revenue Cycle Management - US Healthcare (4-9 yrs)

Role Description :

- The Revenue Cycle Manager responsible for overseeing the end-to-end Revenue Cycle Management process across multiple sites or teams.

- This role involves strategic leadership, operational management, and the implementation of productivity improvement initiatives, particularly focusing on automation and technological advancements.

- As the RCM manager, you will play a critical role in driving efficiency, ensuring customer satisfaction and growth, compliance and achieving financial performance goals while also leading special projects to enhance the organization's RCM's capabilities and profitability.

Responsibilities.

Leadership & Team Management:

- Provide direct leadership and oversight to RCM Associate Manager, Team Leads, Analysts, and other RCM staff.

- Foster a high-performance culture by mentoring and developing team members, ensuring clear communication of goals and expectations.

- Conduct regular performance reviews and provide feedback and coaching to enhance team productivity and morale.

Revenue Cycle Management Oversight:

- Act as a key point of contact for internal and external stakeholders, including clients, vendors, and regulatory bodies.

- Oversee the budgeting process for the RCM department, ensuring efficient use of resources and alignment with organizational financial goals.

- Prepare and present reports on RCM performance, project progress, and process improvements to senior leadership.

- Manage the day-to-day operations of the revenue cycle from insurance verification, billing, coding, claims submission, payment posting, and collections.

- Ensure that all RCM activities are performed efficiently and in alignment with industry best practices and regulatory requirements.

- Ensure that all RCM activities comply with applicable laws, regulations, and accreditation standards, including HIPAA, ICD-10, and payer-specific guidelines.

- Implement and maintain quality assurance processes to ensure accuracy and consistency in billing, coding, and claims submission.

Strategic Planning and KPI Management.

- Develop and implement strategies to optimize revenue cycle performance, focusing on reducing accounts receivable (AR) days, minimizing denials, and improving overall cash flow.

- Establish, monitor, and report on key performance indicators (KPIs) related to revenue cycle efficiency, financial outcomes, and process improvements.

Process improvement, Automation & Special projects.

- Lead initiatives to identify and implement process improvements aimed at enhancing accuracy, efficiency, and revenue capture.

- Drive the adoption of automation and other technology solutions to streamline RCM processes, reduce manual workloads, and improve productivity.

- Collaborate with IT and other departments to ensure successful integration and utilization of new technologies.

- Participate in and lead special projects related to RCM, such as system upgrades, new software implementations, and cross-functional process reengineering efforts.

- Manage project timelines, resources, and budgets, ensuring that projects are completed on time and within scope.

Stakeholder Engagement & Reporting:.

- Act as a key point of contact for internal and external stakeholders, including clients, vendors, and regulatory bodies.

- Prepare and present reports on RCM performance, project progress, and process improvements to senior leadership.

Requirements:

Qualifications:

- Previous management experience in a healthcare setup (5+ years).

- Extensive knowledge of RCM processes for Laboratories and Out patients, healthcare billing and coding, and reimbursement methodologies.

- Exceptional analytical and problem-solving abilities, with experience in using data to drive decision-making and process improvement.

- Proven experience in managing large-scale projects, particularly those involving technology implementation and process reengineering.

- Proficiency with RCM software and automation tools.

- Exceptional analytical and problem-solving abilities, with experience in using data to drive decision-making and process improvement.