Manager_Transition

Job description

**About the Role** We are seeking an experienced **RCM Manager** to lead our Professional (CMS-1500) Billing operations across multiple specialties. This role owns end-to-end billing delivery for existing client accounts, drives **new client/project implementations**, and oversees **EDI and ERA enrollment** functions. The ideal candidate combines strong operational management skills with deep subject-matter expertise in US healthcare provider billing, and has a track record of leading teams through client transitions and go-lives. **Key Responsibilities** **Operations & Team Management** - Manage day-to-day operations of the professional billing team across multiple specialties and client accounts - Set, monitor, and drive team performance against KPIs: clean claim rate, days in AR, denial rate, productivity, and quality/accuracy targets - Conduct regular huddles, one-on-ones, and performance reviews; manage coaching, training, and PIPs as needed - Own workforce planning, shift scheduling, and capacity/utilization management - Build and maintain SOPs, training materials, and quality audit frameworks for the billing function - Escalation point for complex claims, payer issues, and client escalations **New Project / Client Implementation** - Lead billing workstreams for **new client onboarding and transitions**, from kickoff through go-live and stabilization - Partner with Implementation, Credentialing, IT, and Coding teams to define timelines, dependencies, and readiness criteria - Oversee PM/EHR system configuration validation, charge master setup, and fee schedule mapping relevant to billing - Drive parallel billing runs, UAT, and go/no-go decisions for new accounts - Identify workflow gaps and implement process improvements during and after transition - Present implementation status, risks, and readiness updates to internal leadership and client stakeholders **EDI & ERA Enrollment Oversight** - Own the **EDI enrollment** function across payers and clearinghouses, ensuring timely completion and tracking - Oversee **ERA (835) / EFT enrollment** processes, ensuring accurate payer setup for electronic payment posting - Manage relationships and escalations with clearinghouse partners (e.g., Availity, Waystar, Change Healthcare, Office Ally, Trizetto) - Review and approve enrollment trackers; ensure SLAs for enrollment turnaround are met - Troubleshoot systemic EDI/ERA issues impacting claim transmission or payment posting across accounts **Reporting & Stakeholder Management** - Prepare and present operational dashboards and MBRs/QBRs to internal leadership and clients - Analyze denial trends, AR aging, and root causes; drive corrective action plans - Ensure compliance with HIPAA, payer regulations, and internal quality standards - Act as primary liaison between the billing team, client stakeholders, and internal support functions (Credentialing, Coding, IT, AR/Denials) **Required Qualifications** - [8+] years of experience in **US Healthcare Professional (Physician) Billing / RCM**, with at least **3+ years in a supervisory or management role** - Demonstrated experience managing **multi-specialty billing** operations - Proven experience leading **new client/project implementations or transitions** in an RCM environment - Strong working knowledge of **EDI, ERA, and EFT enrollment** processes with payers and clearinghouses - Solid understanding of the full RCM cycle: charge entry, claims submission, denial management, AR follow-up, payment posting - Experience with practice management/EHR systems NextGen, Officeally and E-Clinical Works - Strong knowledge of payer-specific billing guidelines (Medicare, Medicaid, Commercial, Workers' Comp) - Proven ability to manage teams of [15+] FTEs in a production/BPO environment - Strong Excel/reporting skills; experience with dashboards (Power BI, Tableau, or similar) is a plus **Preferred Qualifications** - Experience managing multiple clearinghouse relationships and enrollment escalations - Prior experience in a BPO/KPO environment supporting US healthcare clients - Exposure to Six Sigma/Lean process improvement methodologies **Skills** - Strong leadership, coaching, and people-management skills - Excellent client-facing communication and presentation skills - Analytical mindset with strong problem-solving and decision-making abilities - Ability to manage multiple accounts, specialties, and implementations concurrently - High attention to detail with a strong compliance and quality orientation (HIPAA) - Comfortable operating in a fast-paced, deadline-driven environment