RCM Manager

Job Title: RCM Manager

Overview of the Role:

This role is responsible for the daily operations of the medical Revenue Cycle Management (RCM) department, overseeing claims processing, denial management, collections, and payment posting within a healthcare context.

The RCM Manager will ensure efficient workflows, maximize revenue capture, and continuously improve key performance metrics such as clean claim rates, AR aging, and denial resolution.

The ideal candidate will have a strong grasp of RCM industry standards, exceptional analytical skills, and the ability to lead a team to exceed client service expectations.

This position operates on an EST time schedule.

Key Responsibilities:

Revenue Cycle Operations Oversight:

o Lead all end-to-end medical revenue cycle functions, including claims submission, charge capture, medical billing, payment posting, denial management, and collections, ensuring accuracy and compliance with healthcare industry regulations.

o Establish and maintain efficient workflows, prioritizing high-quality service and prompt claims resolution to minimize AR aging.

o Monitor key revenue cycle metrics (e.g., clean claim rate, denial rate, AR days) to ensure optimal financial performance and adherence to client service standards.

Denial Management and Claims Resolution:

o Oversee the medical claims denial management process, developing strategies to prevent denials, reduce denial rates, and improve overturn rates on appealed claims.

o Collaborate with coding, billing, and follow-up teams to identify denial patterns and implement corrective actions.

o Ensure timely and accurate medical claims resolution, working with insurance companies and clients as needed for complex healthcare claims.

Team Leadership and Development:

o Lead, coach, and develop the RCM team through training and mentorship, aligning performance with department goals.

o Set team goals, regularly review progress, and provide constructive feedback.

o Foster a collaborative culture focused on client satisfaction, efficiency, and professional growth.

Client and Stakeholder Communication:

o Serve as the primary client contact for RCM performance, addressing inquiries, providing updates, and delivering data-driven insights.

o Conduct regular client meetings to review performance, address concerns, and recommend improvements for collections, payment posting, and AR management.

o Collaborate with other departments (e.g., coding, compliance) for cohesive RCM operations.

Process Improvement and Compliance:

o Continuously analyze and optimize RCM workflows to improve efficiency, reduce AR aging, and increase revenue capture, using data and feedback.

o Ensure compliance with federal, state, and industry regulations for claims processing, billing, and collections, maintaining high standards of data security and patient confidentiality.

o Stay informed about industry trends and best practices, implementing relevant changes to enhance RCM services.

Qual...