Operations Manager

Operations Management

• Lead and manage daily operations across Pre-Authorization, Billing, AR Follow-up, and Payment Posting departments.
  
• Ensure timely submission of claims, accurate charge entry, proper payment posting, initiation of accurate pre-authorization and effective follow-up on outstanding AR.
  
• Oversee end-to-end RCM workflow to ensure compliance with U.S. healthcare standards (HIPAA, CMS guidelines).
  
• Monitor and maintain department productivity, quality, and turnaround time (TAT).
  
• Develop, implement, and update standard operating procedures (SOPs).
  

2. Team Leadership

• Supervise team leads and associates across departments; ensure proper staffing, scheduling, and task allocation.
  
• Conduct regular team meetings, reviews, and training sessions.
  
• Identify skill gaps and arrange domain/process training to improve staff competency.
  
• Foster a positive and accountable team culture focused on quality and performance.
  

3. Performance & Quality Control

• Track KPIs such as denial rates, collection efficiency, claim submission TAT, first-pass resolution rate (FPRR), and AR aging.
  
• Review audit findings and implement corrective actions for process improvement.
  
• Collaborate with QA and training teams to maintain accuracy benchmarks (typically >98%).
  

4. Client Communication & Relationship Management

• Act as the key operational point of contact for U.S. clients, ensuring effective communication and SLA compliance.
  
• Handle client escalations and provide timely resolution.
  
• Participate in client calls/reviews to discuss performance reports, issues, and process enhancements.
  

5. Process Improvement & Reporting

• Identify and implement process automation or workflow enhancements to increase efficiency.
  
• Coordinate with IT/automation teams for EHR, PMS, and RPA-based solutions.
  
• Generate and present periodic performance reports to senior management and clients.
  
• Ensure accurate MIS reporting on productivity, aging, and revenue performance.
  

6. Compliance & Governance

• Ensure all team members adhere to HIPAA compliance and data security standards.
  
• Conduct periodic audits to maintain confidentiality and accuracy of patient data.
  
• Support internal/external audits as required by clients or compliance teams.
  

Required Skills & Competencies

• In-depth knowledge of

  U.S. Healthcare RCM process

  Authorization, Billing, AR follow-up, Payment Posting, and Denial Management.
• Strong understanding of

  payer guidelines

  ,

  CPT/ICD codes

  , and

  EOB/ERA reconciliation

  .
• Proven ability to lead multi-department teams (200+ FTEs preferred).
  
• Excellent communication and client-handling skills.
  
• Analytical mindset with experience using

  MS Excel, Power BI, or RCM dashboards

  .
• Ability to multitask, prioritize, and deliver under pressure.
  
• Experience in process transition and ramp-up preferred.
  

Education & Experience

• Bachelor’s degree

  (Healthcare Administration, Business Management, or related field preferred).

• 8–12 years

  of experience in U.S. Medical Billing / RCM operations.

• 3–5 years

  in a managerial or leadership role supervising multiple RCM functions.
• Experience working with major EHR/PMS systems