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

Role

Manager_Transition

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