RCM LEAD

Key Responsibilities

• Manage and oversee daily revenue cycle operations, including:

  • Medical billing

  • Claims submission

  • Payment posting

  • Accounts Receivable (AR) follow-up

  • Denial management

  • Insurance verification

• Ensure timely and accurate claims submission

• Analyze denied/rejected claims and implement corrective actions

• Track and monitor KPIs such as:

  • Clean claim rate

  • Days in AR

  • Denial rates

  • Collection rates

• Ensure compliance with HIPAA, payer guidelines, and healthcare regulations

• Collaborate with providers, operations, and finance teams

• Train, mentor, and support RCM staff

• Conduct audits to identify process gaps and revenue leakage

• Drive process improvements to maximize collections

• Communicate with insurance companies for claims resolution

• Prepare reports and present performance updates to leadership

Nice-to-Have Skills

• High attention to detail and accuracy

• Ability to manage multiple priorities

• Strong leadership and coaching skills

• Process improvement mindset

• Excellent customer service and stakeholder management

Tools: eClinicalWorks