Revenue Cycle Management (RCM) Lead Auditor

We are looking for RCM Lead Auditor for one of our clients ,US based healthcare start up company

Position Overview

The RCM Lead Auditor is responsible for overseeing the entire revenue cycle process, ensuring accurate, timely, and compliant capture, billing, and collection of revenue. This role involves leading a team of RCM specialists, optimizing workflows, monitoring performance metrics, and collaborating with internal and external stakeholders to maximize revenue recovery while maintaining strict regulatory compliance.

Key Responsibilities

1. Operational Management

• Oversee end-to-end revenue cycle operations, including patient registration, charge capture, coding, billing, claims submission, payment posting, accounts receivable follow-up, and denial management.
• Develop, implement, and maintain policies, procedures, and best practices for effective revenue cycle performance.
• Monitor daily, weekly, and monthly workflows to ensure timely resolution of billing issues.

2. Team Leadership

• Lead, mentor, and coach RCM staff, ensuring proper training in coding, billing regulations, and payer requirements.
• Set clear performance expectations (KPIs & SLAs) and conduct regular evaluations.
• Foster a collaborative, high-performance culture.

3. Compliance & Quality Control

• Ensure compliance with all applicable laws, regulations, and payer requirements (HIPAA, ICD-10, CPT, CMS guidelines, etc.).
• Conduct regular audits to identify errors, risks, and improvement opportunities.
• Partner with compliance and quality teams to implement corrective action plans.

4. Authorizations & Benefits Verification

• Oversee prior authorizations, verification of benefits, and accurate calculation of patient responsibility.
• Ensure front- and back-end teams follow proper verification and authorization protocols.

5. Financial & KPI Monitoring

• Track and analyze RCM performance indicators, including Days in A/R, denial rates, collection rates, clean claim rates, and payment posting timelines.
• Prepare and present performance reports to senior management.
• Identify revenue leakage and implement corrective measures to improve financial outcomes.

6. Stakeholder Coordination

• Collaborate with clinical, operational, and finance teams to ensure accurate and timely revenue capture.
• Serve as the escalation point for complex billing and reimbursement issues.
• Maintain effective relationships with insurance providers, vendors, and regulatory agencies.

Qualifications & Skills

Education:

• Bachelor’s degree in Healthcare Administration, Finance, Business Management, or related field.

Experience:

• 5–8 years of progressive experience in revenue cycle management, medical billing, or healthcare finance, including at least 2–3 years in a leadership role.
• Experience in a healthcare provider, hospital, or BPO/RCM outsourcing environment preferred.

Technical Skills:

• Proficiency in medical billing software and EHR/EMR systems.
• Strong knowledge of U.S. coding standards and payer rules (ICD-10, CPT, HCPCS, CMS guidelines).
• Skilled in Google Workspace and MS Office Suite.

Soft Skills:

• Strong leadership, problem-solving, and decision-making abilities.
• Excellent communication and interpersonal skills.
• Ability to work under pressure and manage deadlines effectively.

Key Performance Indicators (KPIs)

• Days in A/R (within industry benchmarks)
• First-pass claim acceptance rate
• Denial rate reduction
• Collection rate improvement
• Timeliness of payment posting
• Employee productivity and accuracy rates

Work Environment

• Willingness to work in U.S. Central Standard Time (CST) hours.
• Full-time role; office-based or hybrid depending on company policy.
• May require extended hours during month-end, quarter-end, or year-end closing.

Immediate joiners/urgent joiners most preferred. Kolkata based candidates/ready to relocate to Kolkata candidates preferred