Role & responsibilities 1. End-to-End RCM Operations Management

* Manage daily RCM operations across multiple functions, including:

* Patient registration and demographics

* Eligibility and benefits verification

* Prior authorization coordination

* Charge entry and charge audit

* Coding coordination

* Claim scrubbing and submission

* Rejection handling

* Payment posting

* Denial management

* AR follow-up

* Appeals and reconsiderations

* Patient statements and patient balance follow-up

* Ensure all claims are processed accurately and within defined turnaround time.

* Monitor daily workflow, inventory, pending claims, denials, and aged AR.

* Ensure timely claim submission, follow-up, correction, and resubmission.

* Coordinate with billing software, clearinghouse, and payer portals as required.

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### 2. Client Communication and Relationship Management

* Act as a key point of contact for assigned clients.

* Conduct regular client calls, operational reviews, and performance discussions.

* Understand client expectations and translate them into actionable internal tasks.

* Share timely updates on work status, issues, escalations, and resolution plans.

* Handle client queries professionally and ensure timely closure.

* Maintain strong client relationships through clear communication, ownership, and transparency.

* Prepare and present weekly/monthly performance review reports to clients.

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### 3. Reporting and Performance Monitoring

* Prepare daily, weekly, and monthly operational reports.

* Track and report key RCM metrics, including:

* Charge lag

* Claim submission TAT

* Rejection rate

* Denial rate

* Net collection rate

* Gross collection rate

* AR aging

* Days in AR

* Payment posting TAT

* Provider productivity

* Coder and biller productivity

* First-pass resolution rate

* No-response and no-action inventory

* Analyze trends in denials, rejections, payment delays, and payer behavior.

* Create dashboards and MIS reports for internal leadership and client review.

* Ensure reports are accurate, clean, and submitted on time.

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### 4. Process Improvement and Automation Support

* Identify workflow gaps, repeated errors, payer issues, and process bottlenecks.





* Recommend process improvements to reduce denials, improve collections, and reduce manual work.

* Create SOPs, checklists, process maps, and training documents.

* Support automation initiatives related to eligibility, claim status, payment posting, denial categorization, and reporting.

* Work with internal teams to standardize workflows across clients.

* Conduct root cause analysis for denials, rejections, and client escalations.

* Implement corrective and preventive action plans.

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### 5. Team Management

* Manage team leads, senior executives, AR callers, payment posters, charge entry staff, and denial specialists.

* Allocate work based on priority, volume, skill level, and client requirements.

* Monitor productivity, quality, attendance, and adherence to process standards.

* Conduct daily huddles and weekly team reviews.

* Train team members on payer rules, client requirements, denial handling, and documentation standards.

* Provide feedback, coaching, and performance improvement plans where needed.

* Ensure backup planning and smooth coverage during leaves or workload spikes.

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### 6. Quality and Compliance

* Ensure accuracy in claim submission, payment posting, denial actions, and client updates.

* Monitor quality audits and error trends.

* Ensure all team members follow HIPAA, PHI, payer, and client confidentiality requirements.

* Maintain proper documentation of actions taken on claims and accounts.

* Ensure compliance with client SOPs, payer guidelines, and internal policies.

* Support internal and external audits.

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### 7. Escalation Handling

* Handle payer escalations, client escalations, delayed payments, repeated denials, and unresolved AR issues.

* Coordinate with providers, coders, billing teams, clearinghouses, and payers to resolve complex issues.

* Track escalations until closure.





* Provide explicit RCA and action plans for repeated issues.

* Ensure urgent items are prioritized and resolved within agreed timelines.

Required Skills

* Strong knowledge of *end-to-end U.S. Healthcare RCM*

* Experience in managing client communication

* Strong understanding of claims, denials, AR, payment posting, and billing workflows

* Ability to analyze reports and identify trends

* Valuable knowledge of payer portals and clearinghouse workflows

* Strong Excel and reporting skills

* Ability to manage teams and drive productivity

* Good written and verbal English communication

* Strong problem-solving and escalation handling ability

* Ability to create SOPs, process documents, and performance reports

* Good understanding of HIPAA and PHI compliance

Preferred candidate profile

Experience with any of the following is preferred:

* EZClaim, AdvancedMD, eClinicalWorks, Kareo, Athena, Epic, Cerner, Medisoft, DrChrono, or other billing systems

* Waystar, Availity, Trizetto, Office Ally, Change Healthcare, or other clearinghouses

* Medicare, Medicaid, commercial insurance, workers compensation, and Medicare Advantage plans

* Specialties such as hospitalist, oncology, anesthesia, radiology, emergency medicine, internal medicine, or primary care

* Power BI, advanced Excel, Google Sheets, dashboards, and automation workflows

* Handling U.S. healthcare client meetings independently

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## Key Performance Indicators

The Assistant Manager will be measured on:

* Claims submitted within TAT

* Reduction in denials and rejections

* AR aging improvement

* Collection improvement

* Client satisfaction

* Report accuracy and timeliness

* Team productivity and quality

* Escalation closure rate

* Process improvement implementation

* SOP adherence

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## Qualification

* Graduate degree required; healthcare, life sciences, commerce, or management background preferred.

* Minimum 5 years of experience in U.S. Healthcare RCM.

* Minimum 1–2 years of team lead or assistant manager-level experience preferred.

* Strong experience in client communication and operational reporting is mandatory.

📌 Assistant Manager End To End RCM Operations (Hyderabad)
🏢 Zebl India Private
📍 Hyderabad