Senior Leader for US Healthcare RCM

Role SummaryLead end‑to‑end RCM operations for India delivery centers, ensuring accurate, compliant, and efficient revenue cycle services (front-end, mid-cycle, and back-end) for US healthcare clients. Drive operational excellence, automation, and scalability while meeting financial, quality, and client satisfaction targets.Key responsibilities- Own overall RCM operations (coding, charge entry, billing, payment posting, AR, denials, credit balance, refunds) for assigned portfolios. - Translate organizational and client strategy into operational plans, targets, and SOPs for India delivery teams. - Define, implement, and continuously refine processes to improve clean-claim rate, reduce denials and AR days, and accelerate collections. - Establish robust governance: daily/weekly ops reviews, SLA dashboards, root-cause analysis, and corrective action plans. - Drive productivity and quality improvement through standardization, automation, and use of analytics and RPA/AI where feasible. - Manage P&L / budget for RCM operations; track revenue, cost per FTE, productivity, and margins, and execute cost-optimization initiatives. - Build and lead a strong management layer (AVPs/Directors/Managers) and ensure effective span of control and succession planning. - Ensure compliance with client contracts, payer rules, HIPAA, information security, and internal audit / QA requirements. - Partner with Training, Quality, HR, and Technology to drive hiring, onboarding, capability building, and engagement for large RCM teams. - Champion a culture of accountability, continuous improvement, and data-driven decision-making.Candidate profile- 15+ years of experience in US Healthcare RCM / medical billing BPO, with at least 5–7 years in senior operations leadership managing large teams (300+ FTE) across multiple processes / sites. - Deep understanding of end-to-end RCM workflows, payer requirements, reimbursement methodologies, and denial management. - Proven track record of improving AR, denials, cash flow, and cost metrics at scale. - Strong P&L management, planning, and analytical skills; comfortable working with complex dashboards and operational data. - Excellent stakeholder management and communication skills for US client leadership and internal management interactions. - Experience running India delivery for US clients, preferably in a 24x7 / US shift environment.KPIs and Operational MetricsFinancial / Revenue KPIs- Net collection rate (% of collectible revenue actually collected). - Gross and net days in AR (overall and by payer). - Bad debt / write-off as % of net revenue. - Cost to collect (operations cost as % of cash collected). - Revenue leakage identified and recovered (through audits / analytics).Billing and claim performance- First-pass / clean-claim rate (% of claims paid without edits/denials). - Claim rejection rate (clearinghouse / payer rejections). - Average claim submission TAT from DOS / encounter closure. - Rebill / corrected claim rate.Denials and AR performance- Overall denial rate (% of claims denied at first pass). - Denial overturn rate (% of appealed denials successfully reversed). - Average denial resolution TAT. - AR age distribution (0–30, 31–60, 61–90, 91–120, >120 days) with specific targets for AR > 90 / 120 days. - % of no‑response / aged follow-up inventory.Productivity and quality- Productivity per FTE by function (e.g., claims processed/FTE/day, calls/FTE/day, dollars worked/FTE/day). - Quality / accuracy rate (e.g., error rate for coding, charge entry, payment posting, denial actions). - Rework rate (% of accounts needing reprocessing due to internal errors). - SLA adherence across all processes (TAT, quality, compliance).Client and people metrics- Client satisfaction / NPS scores; number of escalations and their resolution TAT. - Attrition (voluntary and involuntary) and average tenure by band. - Employee engagement score and training hours per FTE. - Leadership pipeline health (internal promotions, bench strength for critical roles).#RevenueCycleManagement #RCMOperations #HealthcareRCM #MedicalBilling #DenialManagement #ARManagement #ClaimsProcessing #OperationsLeadership #ProcessExcellence #ContinuousImprovement #DataDriven #Automation #RPA #AIInHealthcare #HIPAACompliance #QualityExcellence #TeamLeadership #EmployeeEngagement #ClientSatisfaction #OperationalExcellence

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