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Senior Leader For Us Healthcare Rcm
Senior Leader For Us Healthcare RcmVistec Partners • Faridabad, Gurgaon (division), India
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Senior Leader For Us Healthcare Rcm

Senior Leader For Us Healthcare Rcm

Vistec Partners • Faridabad, Gurgaon (division), India
3 days ago
Job description

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 perFTE, 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).
  • #RevenueCycleManagement #RCMOperations #HealthcareRCM #MedicalBilling #DenialManagement #ARManagement #ClaimsProcessing #OperationsLeadership #ProcessExcellence #ContinuousImprovement #DataDriven #Automation #RPA #AIInHealthcare #HIPAACompliance #QualityExcellence #TeamLeadership #EmployeeEngagement #ClientSatisfaction #OperationalExcellence

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