Manager_Transition

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