Senior Leader Healthcare RCM

Position: Senior Leader for US Healthcare RCM
Role Summary

Lead 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 Metrics

Financial / 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).

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