Job Title: Project Manager –Operations
Experience: 8+ Years
Preferred Locations: Bangalore and North India (Equal Priority); Chennai (Lower Priority)
Job Description:
We are looking for experienced Project Managers to lead AR and Denial Management operations for US Healthcare clients. The ideal candidates should have strong client management, operational expertise, team leadership, and a proven track record of improving collections, reducing denials, and maintaining service quality.
Key Responsibilities:
- Lead client meetings, operational performance reviews, and executive-level business reviews.
- Monitor AR ageing, collections, cash acceleration, and denial overturn rates to achieve client targets.
- Identify denial root causes and implement corrective actions to reduce repeat denials and revenue leakage.
- Manage high-balance accounts, payer escalations, timely filing issues, and clearinghouse EDI failures.
- Lead and mentor AR Team Leads, Senior Denial Specialists, and Billing Associates.
- Track team productivity, resolution rates, appeal success rates, and quality performance metrics.
- Advise clients on workflow improvements related to patient access, prior authorisation, and insurance verification.
- Ensure compliance with CMS guidelines, Medicare Part B, Medicaid regulations, commercial payer policies, and LCD/NCD guidelines.
- Conduct quality audits, deliver refresher training, and develop SOPs for denial management, payer escalations, and billing processes.
- Plan resource capacity and shift coverage while ensuring operational performance and client satisfaction.
Candidate Requirements:
- 8+ years of experience in US Healthcare Revenue Cycle Management (RCM).
- Minimum 3 years of team-handling experience in AR and Denial Management.
- Proven experience independently managing client relationships and executive-level business reviews.
- Strong knowledge of AR ageing, denial management, appeals, payer escalation, and collections.
- Experience in performance management, quality audits, process improvement, and SOP development.
- Hands-on experience with healthcare billing systems, practice management software, clearinghouses, and payer portals.
- Excellent communication, analytical, problem-solving, and leadership skills.
- Must be comfortable working night shifts with flexibility based on client and operational requirements.
Preferred Qualifications:
- Graduate degree in Commerce, Healthcare Administration, Business Administration, or a related field; MBA preferred.
- Certifications such as CPC, CRCR, or Six Sigma are an added advantage.
Performance Expectations:
- Maintain AR over 90 days within the target benchmark.
- Drive denial reduction and improve appeal overturn rates.
- Maintain a quality audit score of 95% or higher.
- Achieve client-defined productivity, resolution, and cash collection targets.
