RCM Operations Director

Role SummaryLead end‑to‑end RCM operations for India delivery centers, ensuring accurate, compliant, and efficient revenue cycle services (front-end, mid-cycle, and back-end) for US healthcare clients. Drive operational excellence, automation, and scalability while meeting financial, quality, and client satisfaction targets.Key responsibilitiesOwn overall RCM operations (coding, charge entry, billing, payment posting, AR, denials, credit balance, refunds) for assigned portfolios.Translate organizational and client strategy into operational plans, targets, and SOPs for India delivery teams.Define, implement, and continuously refine processes to improve clean-claim rate, reduce denials and AR days, and accelerate collections.Establish robust governance: daily/weekly ops reviews, SLA dashboards, root-cause analysis, and corrective action plans.Drive productivity and quality improvement through standardization, automation, and use of analytics and RPA/AI where feasible.Manage P&L / budget for RCM operations; track revenue, cost perFTE, productivity, and margins, and execute cost-optimization initiatives.Build and lead a strong management layer (AVPs/Directors/Managers) and ensure effective span of control and succession planning.Ensure compliance with client contracts, payer rules, HIPAA, information security, and internal audit / QA requirements.Partner with Training, Quality, HR, and Technology to drive hiring, onboarding, capability building, and engagement for large RCM teams.Champion a culture of accountability, continuous improvement, and data-driven decision-making.Candidate profile15+ years of experience in US Healthcare RCM / medical billing BPO, with at least 5–7 years in senior operations leadership managing large teams (300+ FTE) across multiple processes / sites.Deep understanding of end-to-end RCM workflows, payer requirements, reimbursement methodologies, and denial management.Proven track record of improving AR, denials, cash flow, and cost metrics at scale.Strong P&L management, planning, and analytical skills; comfortable working with complex dashboards and operational data.Excellent stakeholder management and communication skills for US client leadership and internal management interactions.Experience running India delivery for US clients, preferably in a 24x7 / US shift environment.KPIs and Operational MetricsFinancial / Revenue KPIsNet collection rate (% of collectible revenue actually collected).Gross and net days in AR (overall and by payer).Bad debt / write-off as % of net revenue.Cost to collect (operations cost as % of cash collected).Revenue leakage identified and recovered (through audits / analytics).Billing and claim performanceFirst-pass / clean-claim rate (% of claims paid without edits/denials).Claim rejection rate (clearinghouse / payer rejections).Average claim submission TAT from DOS / encounter closure.Rebill / corrected claim rate.Denials and AR performanceOverall denial rate (% of claims denied at first pass).Denial overturn rate (% of appealed denials successfully reversed).Average denial resolution TAT.AR age distribution (0–30, 31–60, 61–90, 91–120, > 120 days) with specific targets for AR > 90 / 120 days.% of no‑response / aged follow-up inventory.Productivity and qualityProductivity per FTE by function (e.G., claims processed/FTE/day, calls/FTE/day, dollars worked/FTE/day).Quality / accuracy rate (e.G., error rate for coding, charge entry, payment posting, denial actions).Rework rate (% of accounts needing reprocessing due to internal errors).SLA adherence across all processes (TAT, quality, compliance).Client and people metricsClient satisfaction / NPS scores; number of escalations and their resolution TAT.Attrition (voluntary and involuntary) and average tenure by band.Employee engagement score and training hours per FTE.Leadership pipeline health (internal promotions, bench strength for critical roles).#RevenueCycleManagement #RCMOperations #HealthcareRCM #MedicalBilling #DenialManagement #ARManagement #ClaimsProcessing #OperationsLeadership #ProcessExcellence #ContinuousImprovement #DataDriven #Automation #RPA #AIInHealthcare #HIPAACompliance #QualityExcellence #TeamLeadership #EmployeeEngagement #ClientSatisfaction #OperationalExcellence