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