RCM Operations Lead

About the Role

The RCM Operations Lead will sit at the center of the billing function, overseeing claim management, vendor relationships, and managing an offshore RCM team. This is a high-ownership role that requires a proactive approach, prioritizing tasks, and ensuring seamless execution of billing operations.

What You Will Do

• Own end-to-end billing operations across the full claims lifecycle, from front-end insurance verification and prior auth through claim submission, follow-up, denial/rejection resolution, and back-end reporting
• Lead and manage a team of 4+ offshore support staff, setting priorities, assigning workstreams, reviewing output, and keeping the team on track
• Serve as the escalation point when issues arise, ensuring processes are running consistently and correctly across the team
• Manage a high volume of billing questions and escalations from vendors and internal teams, investigating patient responsibility questions, handling vendor escalations, and triaging high-priority items
• Support ad-hoc RCM projects, including state launches, new payer setup, provider enrollment, and credentialing gaps for existing clinicians
• Collaborate with internal teams to resolve billing-related issues and improve overall revenue cycle efficiency
• Develop and implement process improvements to increase billing accuracy and reduce denials
• Analyze and resolve complex billing issues, identifying root causes and implementing corrective actions
• Stay up-to-date with industry trends, regulatory changes, and best practices in revenue cycle management

What We Are Looking For

• 5+ years of hands-on RCM experience, with strong familiarity across the claims lifecycle: denials, rejections, adjustments, resubmissions
• Comfortable in Availity and standard provider portals
• Ownership-oriented, with a proactive approach to managing workflows and resolving issues
• Clear communicator, able to surface key information in a format others can act on
• Comfortable in a fast-moving environment, with startup or high-growth experience preferred
• Strong analytical and problem-solving skills, with the ability to manage multiple workstreams simultaneously
• Experience managing offshore teams and vendors, with a strong understanding of billing operations and revenue cycle management
• Familiarity with insurance verification, prior authorization, and claim submission processes

Nice to Have

• Experience with electronic health records (EHRs) and practice management systems (PMS)
• Knowledge of HIPAA regulations and compliance requirements
• Certification in revenue cycle management or a related field, such as CRCR or CPAR
• Experience with data analysis and reporting tools, such as Excel or Tableau
• Familiarity with state-specific billing regulations and requirements

Benefits and Perks

• Competitive salary and benefits package
• Opportunity to work with a mission-driven company making a positive impact in the healthcare industry
• Collaborative and dynamic work environment with a high-ownership team
• Professional development and growth opportunities, with a focus on revenue cycle management and healthcare operations
• Flexible working hours and remote work arrangement
• Access to cutting-edge technology and tools, including Availity and standard provider portals
• Comprehensive health insurance and wellness programs
• Generous PTO and holiday package

• tip: Highlight your experience with revenue cycle management and billing operations, including any relevant certifications or training.
• tip: Be prepared to discuss your approach to managing complex billing issues and your experience with electronic health records (EHRs) and practice management systems (PMS).
• tip: Show examples of process improvements you've implemented in previous roles, and how they've positively impacted revenue cycle efficiency.
• tip: Research the company's mission and values, and be prepared to discuss how your skills and experience align with their goals.
• tip: Consider creating a portfolio or samples of your work, including reports, analyses, or process improvement projects, to demonstrate your skills and expertise.
• tip: Be prepared to negotiate salary and benefits, and have a clear understanding of your worth in the market.
• tip: Look for red flags such as unclear expectations, lack of communication, or unrealistic goals, and be prepared to address any concerns you may have during the interview process.