RCM Director (AR Hospital Insurance)

Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. The RCM insurance AR back-office collections Director is responsible for overseeing and coordinating all revenue cycle back-office activities, with a focus on maximizing reimbursement in a cost-effective manner. This role ensures compliance with federal, state, and payer-specific billing requirements.

RCM provider Director will be responsible for displaying thought leadership at an enterprise level as a company and help exceed Hospital / Health system delivery KPIs metrics for Acute & Ambulatory scope of work. Will be responsible for not just meeting but exceeding SLA’s by continuously improving, enhancing & transforming upstream/ downstream workflow & process flows across multiple functions & thereby outperforming as leader.

Primary Responsibilities:

• End to End RCM thought leadership: Establish credibility with end clients (hospitals and providers) along with domestic stakeholders to enhance resolution-based outcome & enhance project KPIs and SLAs delivery. Provide analytics & insights through payer provider upstream/ downstream knowledge, coding & billing rules & guideline adherence/ implementation, payers best practices & PHI compliance adherence.
• Oversee Daily Operations: Manage all Patient Financial Services (PFS) functions, including billing, follow-up, collections, and cash posting.
• Collaboration: Work closely with other departments (e.g., HIM, Case Management, IT) to streamline procedures and ensure timely billing.
• Staff Management: Direct the selection, supervision, and evaluation of staff, ensuring performance evaluations are conducted timely.
• Compliance: Ensure adherence to regulatory requirements related to patient accounting, including Medicare, Medicaid, and managed care processes.
• Financial Analysis: Read, analyze, and interpret financial reports, contracts, and other legal documents.
• Problem-Solving: Identify and correct operating issues to maximize cash flow and improve department performance.
• Customer Service: Maintain excellent customer service standards.
• Transformation: Drive/participate in effective innovation and transformation implementation and delivery of client services & solutions in collaboration with onshore partners/ technology/ innovation teams
• Corporate policies & procedures: Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Qualifications

• Bachelor’s degree in healthcare administration, Business, Accounting, Finance, or a related field.
• 15+ years of experience in Revenue cycle management back operations
• 3+ years of leadership level experience in hospital revenue cycle, with expertise in billing and collections
• Excellent communication & presentation skills
• Strong analytical, critical and problem-solving skills leader with ability to work independently.
• Proven record to articulate business strategies and formulate concise solutions to complex problems
• Ability to champion change management, consult with versatility, exhibit personal leadership and model a customer orientation that will drive results in a dynamic, matrixed environment with a high degree of organizational growth and ambiguity
• Open to travel across globe per business needs and ability to travel to other sites as needed (Taguig, Muntinlupa, Cebu etc.) per strategy defined with the leaders.
• Knowledge of MS office & its tools (intermediate to advance level)

Preferred skills:

• Knowledge of front middle and back functions in RCM: patient registration, financial clearance, cash posting, customer service, patient AR etc.