RCM Manager

The RCM Manager is responsible for overseeing the end-to-end revenue cycle process, including insurance verification, pre-authorizations, claims submission, follow-ups, and collections. The role ensures accurate billing, timely reimbursements, and compliance with payer and regulatory requirements, ultimately optimizing the organization’s revenue and cash flow.Key Responsibilities and expectations include accurate billing, timely reimbursements, and adherence to payer and regulatory requirements, optimizing revenue and cash flow.Key Responsibilities1. Claims ManagementOversee accurate and timely submission of insurance claimsEnsure compliance with payer requirements and coding standardsMonitor claim rejections and denials, and implement corrective actions2. Insurance & ApprovalsManage pre‑authorization and approval processes with insurance providersEnsure eligibility checks and coverage validation prior to servicesLiaise with insurers to resolve approval‑related issues3. Denials & Collections ManagementAnalyze denial trends and implement strategies to reduce rejection ratesOversee resubmissions and appeals for denied claimsEnsure timely collections and follow‑up on outstanding receivables4. Revenue OptimizationIdentify revenue leakage and implement corrective measuresImprove billing accuracy and turnaround times5. Team ManagementLead and manage the RCM team including billing, coding, and collections staffProvide training and continuous development for team membersSet performance targets and monitor team productivity6. Systems & ComplianceEnsure effective use of HIS, billing systems, and insurance platforms (e.g., NPHIES)Maintain compliance with local regulations and insurance guidelinesCoordinate with clinical and finance teams for accurate documentation#J-18808-Ljbffr