RCM Manager

Role Overview

RCM Manager at NMC Healthcare. This role oversees the complete revenue cycle management function, leading a team responsible for patient registration, eligibility verification, billing, claims processing, payment posting, denial management, and collections.

Role Purpose

To manage and optimize the entire healthcare revenue cycle, ensure accurate and timely claim submission and payment collection, lead and develop the RCM team to meet operational and financial targets, maintain compliance with healthcare regulations and payer requirements, and identify process improvements and cost-reduction opportunities.

Key Responsibilities

Revenue Cycle Operations

• Manage the complete revenue cycle from patient registration and eligibility verification through billing, claims processing, payment posting, denial management, and collections.
• Oversee accurate and timely submission of insurance claims.
• Ensure accurate payment posting, reconciliation, and follow-up on unpaid or partially paid claims.

Claims & Denial Management

• Analyze and resolve claim denials, rejections, underpayments, and payment discrepancies.
• Develop and implement processes to reduce claim errors, improve clean-claim rates, and accelerate collections.

Accounts Receivable Management

• Monitor outstanding accounts receivable and develop strategies to reduce aging balances.

Stakeholder Management

• Maintain effective relationships with insurance companies, TPAs, and other payers.
• Review payer contracts, reimbursement terms, and payment trends to identify revenue-impacting issues.
• Work with Medical Coding and Clinical teams to address documentation, coding, and billing discrepancies.
• Coordinate with Finance and Accounting for reconciliation of collections and receivables.

Team Leadership & Development

• Lead, supervise, and develop the RCM team, including billing, claims, AR, denial, and collection staff.
• Establish team KPIs and conduct regular performance reviews.

Performance Monitoring & Reporting

• Monitor daily, weekly, and monthly RCM performance and ensure achievement of operational and financial targets.
• Prepare and present RCM dashboards and management reports covering KPIs, AR aging, collections, denials, and claims performance.

Process Improvement & Compliance

• Identify recurring billing and coding issues and coordinate corrective actions with relevant departments.
• Identify opportunities for automation, process improvement, and cost reduction within the revenue cycle.
• Ensure compliance with applicable healthcare regulations, payer requirements, internal policies, and data-protection standards.
• Support internal and external audits and ensure timely resolution of audit findings.

Risk Management

• Escalate significant payer, operational, compliance, or revenue risks to senior management.

Qualifications & Experience

• Bachelor's degree in Healthcare Management, Finance, Business Administration, Accounting, or a related field.
• 5–8 years of experience in healthcare revenue cycle management, including 2–3 years in a supervisory or managerial role.
• Strong knowledge of medical billing, claims processing, denial management, AR follow-up, and payer processes.
• Experience working with healthcare providers, insurance companies, and TPAs.
• Professional certification in RCM, medical billing, coding, or healthcare management is an advantage.

Skills & Competencies

• Strong analytical and problem-solving skills.
• Strong leadership and communication skills.
• Proficiency in MS Excel and healthcare billing/RCM systems.
• Experience with dashboards, KPI reporting, and process improvement.