Client Management & Communication
•Support the RCM leadership team in managing assigned client accounts and day-to-day client requirements.
•Act as a secondary point of contact for clients and provide coverage in the absence of the primary client lead.
•Participate in weekly, monthly, and quarterly client meetings and operational reviews.
•Prepare meeting agendas, performance summaries, action trackers, and follow-up communications.
•Ensure client questions, concerns, and escalations are acknowledged and resolved within agreed timelines.
•Coordinate with internal teams to provide accurate and timely updates to clients.
•Build strong working relationships with client stakeholders and internal functional teams.
RCM Operations Management
•Monitor end-to-end revenue cycle performance across assigned clients.
•Coordinate activities across Coding, Charge Entry, Claims, AR, Denials, Payment Posting, Prior Authorization, Eligibility, Enrollment/Credentialing, and Patient Accounts.
•Identify operational gaps affecting collections, claim submission, reimbursement, or client satisfaction.
•Ensure appropriate follow-up on high-dollar claims, aged AR, unresolved denials, and payer-related issues.
•Track operational dependencies and ensure issues are assigned to appropriate teams for resolution.
•Support new client implementations, system transitions, payer changes, and operational workflow changes.
KPI & Performance Management
Monitor and analyze key RCM metrics, including:
•Days in AR
•AR aging, particularly 90+ and 120+ AR
•Gross and net collections
•Charge and payment trends
•Denial rate and denial trends
•Clean claim / first-pass acceptance rate
•Claim submission turnaround time
•Coding turnaround time
•Payment posting turnaround time
•Average claim touches
•Productivity and quality
•Prior authorization performance
•Enrollment and credentialing-related claim holds
Identify negative trends early and work with operational teams to develop corrective action plans.
AR & Denial Management
•Review AR aging and identify opportunities for accelerated collections.
•Monitor high-dollar and aged accounts requiring escalation.
•Analyze denial trends by payer, provider, CPT, denial reason, and root cause.
•Coordinate with Coding, Enrollment, Authorization, and AR teams to resolve recurring denial issues.
•Monitor timely filing limits and ensure claims at risk are prioritized appropriately.
•Track appeals, reconsiderations, corrected claims, and payer escalations through resolution.
•Support initiatives to reduce rework and prevent avoidable denials.
Reporting & Analytics
•Prepare weekly and monthly operational dashboards and client performance reports.
•Analyze charge, payment, adjustment, denial, and AR trends.
•Validate data before presenting reports to clients or leadership.
•Highlight performance improvements, risks, root causes, and action plans.
•Provide meaningful insights rather than simply reporting metrics.
•Maintain trackers for escalations, payer issues, client requests, and outstanding action items.
Cross-Functional Coordination
Work closely with:
•AR & Denials
•Coding
•Charge Entry
•Payment Posting
•Prior Authorization
•Eligibility
•Enrollment/Credentialing
•Patient Services
•Quality
•Training
•IT/Development
•Client Success
•RCM Leadership
Ensure cross-functional dependencies are identified, communicated, tracked, and resolved without negatively affecting client performance.
Escalation Management
•Identify operational and client risks before they become major escalations.
•Maintain ownership of escalated issues until closure.
•Coordinate root-cause analysis for recurring operational issues.
•Escalate high-risk items to RCM leadership with supporting data and recommended next steps.
•Maintain clear documentation of decisions, action items, owners, and expected completion dates.
Process Improvement
•Identify opportunities to improve productivity, quality, collections, and turnaround times.
•Support workflow standardization and automation initiatives.
•Work with leadership and technology teams to reduce manual processes and unnecessary claim touches.
•Participate in root-cause analysis and corrective/preventive action initiatives.
•Support implementation of operational best practices across multiple client accounts.
Required Skills & Competencies
•Strong understanding of U.S. healthcare Revenue Cycle Management.
•Knowledge of physician/professional billing processes.
•Strong understanding of AR, denials, claims, coding, payment posting, eligibility, authorization, and enrollment workflows.
•Knowledge of Medicare, Medicaid, Commercial, Workers' Compensation, and Medicare Advantage payer processes.
•Strong analytical and problem-solving skills.
•Ability to interpret operational and financial RCM reports.
•Strong written and verbal communication skills.
•Ability to communicate confidently with clients and senior leadership.
•Strong ownership and follow-through.
•Ability to manage multiple clients, priorities, and deadlines simultaneously.
•Advanced working knowledge of Excel and reporting tools.
•Experience working with practice management systems, clearinghouses, and payer portals.
Software / Practice Management System Knowledge
The candidate should have hands-on experience working with multiple Practice Management (PM) and Electronic Health Record (EHR) platforms, including:
•eClinicalWorks (eCW)
•Tebra
•Cerner
•athenahealth (Athena)
The candidate should be comfortable navigating these systems for charge review, claim status, AR follow-up, denial management, payment review, reporting, and account-level analysis.
Specialty Experience
