Manager_Transition

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