RCM Operations Manager

Job Title

RCM Operations Manager

Department

US Healthcare – Revenue Cycle Management

Location

Hyderabad, Telangana, India

Employment Type

Full-Time

Shift

US Shift (Night Shift)

Reporting To

Head of Operations / Director of Operations

Job Summary

We are seeking an experienced and results-driven RCM Operations Manager to oversee end-to-end Revenue Cycle Management operations for US healthcare clients. The ideal candidate will have strong expertise in medical billing, accounts receivable (AR), denial management, payment posting, collections, and operational performance management.

The RCM Operations Manager will be responsible for managing multiple teams, optimizing revenue cycle performance, achieving client-defined service-level agreements (SLAs), improving collections, reducing claim denials, and maintaining operational quality and compliance. The role requires strong leadership, analytical, client management, and process improvement capabilities.

Key Responsibilities

A. End-to-End RCM Operations Management

• Oversee daily medical billing operations, including eligibility verification, charge entry, claim submission, payment posting, accounts receivable follow-up, denial management, and appeals.
• Ensure accurate, timely, and compliant processing of medical claims in accordance with payer guidelines and client requirements.
• Manage multiple processes, teams, and client accounts to ensure smooth operational delivery.
• Monitor outstanding claims, reimbursement delays, underpayments, and revenue leakage.
• Establish operational priorities and implement strategies to maximize collections and improve cash flow.
• Ensure adherence to agreed turnaround times, productivity standards, and contractual SLAs.

B. Team Leadership and People Management

• Lead and manage Team Leads, Supervisors, Medical Billers, AR Callers, and other RCM professionals.
• Define team objectives, assign responsibilities, and monitor individual and departmental performance.
• Conduct regular performance reviews, operational meetings, and productivity assessments.
• Develop training plans to improve employee knowledge, process accuracy, and operational efficiency.
• Identify skill gaps and implement coaching, cross-training, and succession planning.
• Manage staffing requirements, resource allocation, workforce planning, and employee retention.
• Promote accountability, teamwork, and continuous improvement across all operational teams.

C. Revenue Optimization and Denial Management

• Develop strategies to improve collections, reduce outstanding AR, and minimize revenue leakage.
• Monitor claim denial trends and conduct root-cause analysis to identify recurring issues.
• Drive corrective and preventive actions to improve clean claim rates and first-pass resolution.
• Oversee timely resolution of rejected, denied, underpaid, and unpaid claims.
• Establish escalation procedures for high-value claims, complex denials, and payer-related issues.
• Coordinate with clients and internal teams to resolve reimbursement discrepancies.
• Monitor payer performance and identify opportunities for improved reimbursement and collection efficiency.

D. Performance Monitoring and Reporting

• Define, monitor, and review key operational performance indicators (KPIs).
• Prepare and present daily, weekly, and monthly operational performance reports.
• Analyze productivity, quality, collections, denial rates, AR aging, and staffing performance.
• Track actual performance against business goals, client SLAs, and operational budgets.
• Develop action plans for underperforming teams and processes.
• Present performance trends, business risks, and improvement initiatives to senior management.

E. Client Relationship and Stakeholder Management

• Serve as a primary operational point of contact for assigned US healthcare clients.
• Conduct regular client meetings, business reviews, and performance discussions.
• Communicate operational updates, performance results, challenges, and corrective action plans.
• Manage escalations related to billing accuracy, collections, claim denials, and service delivery.
• Build strong client relationships through proactive communication and consistent performance.
• Support client onboarding, new process transitions, volume ramp-ups, and additional service requirements.

F. Process Improvement and Operational Excellence

• Identify workflow inefficiencies and implement process optimization initiatives.
• Standardize operating procedures (SOPs) and ensure consistent execution across teams.
• Drive automation opportunities and effective utilization of billing systems, reporting tools, and workflow platforms.
• Establish quality control mechanisms and continuous improvement programs.
• Conduct periodic operational reviews to identify risks, bottlenecks, and opportunities for cost reduction.
• Support the implementation of new technologies and process changes to improve efficiency and scalability.

G. Quality, Compliance, and Risk Management

• Ensure adherence to HIPAA privacy and security requirements and applicable US healthcare regulations.
• Maintain the confidentiality and security of protected health information (PHI).
• Ensure compliance with client contracts, payer policies, internal SOPs, and audit requirements.
• Oversee quality audits and implement corrective action plans for recurring errors.
• Identify operational, compliance, and revenue-related risks and establish appropriate controls.
• Ensure appropriate access controls, documentation, and reporting procedures are followed.

H. Financial and Business Management

• Monitor operational costs, staffing expenses, productivity, and resource utilization.
• Support budgeting, forecasting, and workforce planning for assigned operations.
• Analyze operational profitability and identify opportunities to improve margins.
• Work with senior management to establish business tar