Process Head - RCM

Job Duties/Responsibilities: 

• Provide overall leadership and strategic direction for the Enterprise department. 
  

• Define and implement long-term departmental strategies aligned with organizational objectives and growth plans. 
  

• Oversee multi-layer leadership teams (Senior Managers, Managers, Process Leads, and Client Account Leads) and ensure accountability across service delivery. 
  

• Own financial outcomes, including revenue performance, client profitability, cost optimization, budgeting, and financial stewardship. 
  

• Drive business growth by identifying expansion opportunities, supporting new client acquisitions, and strengthening strategic partnerships across existing accounts. 
  

• Serve as the executive sponsor for key client relationships, ensuring long-term partnership success, client retention, and achievement of contractual commitments. 
  

• Lead strategic client governance, including executive escalations, Quarterly Business Reviews (QBRs), Year-to-Date (YTD) performance reviews, contract renewals, and business growth discussions. 
  

• Monitor and drive performance across all RCM functions, including charge posting, payment posting, accounts receivable (AR), denials management, reporting, and client governance. 
  

• Review AHT vs. FTE utilization, workforce capacity, and operational efficiency metrics, implementing optimization strategies to improve productivity and scalability. 
  

• Establish and monitor operational governance frameworks to ensure effective decision-making, performance management, and accountability across all leadership levels. 
  

• Own risk management and business continuity planning, ensuring proactive identification and mitigation of operational, financial, and delivery risks. 
  

• Ensure compliance with HIPAA, ISMS, QMS, payer regulations, client requirements, and other applicable regulatory standards. 
  

• Drive adoption of automation, analytics, AI/GenAI, and BOT solutions to enhance operational efficiency, scalability, and customer experience. 
  

• Foster innovation, leadership development, succession planning, and organizational capability building across the department. 
  

• Collaborate with Finance, Compliance, HR, Technology, and other cross-functional teams to support budgeting, audits, workforce planning, and digital transformation initiatives. 
  

General Responsibilities 

• Promote a culture of excellence, innovation, accountability, and client-first delivery. 
  

• Ensure transparent communication with clients and internal leadership. 
  

• Foster innovation, talent development, and succession planning within leadership layers. 
  

• Represent the department in executive forums, client summits, and industry events
  

Required Qualifications: 

• Bachelor’s degree or higher (MBA, MHA, or equivalent strongly preferred) 
  

• 15+ years of end-to-end RCM experience with at least 5+ years in senior leadership roles 
  

• Proven experience in managing large, multi-practice RCM operations across specialties 
  

• Strong financial acumen including P&L ownership, budgeting, cost optimization, and AHT vs. FTE management. 
  

• Experience in all specialty Revenue Cycle Management with strong understanding of reimbursement methodologies, payer policies, authorization requirements, denial management, and operational performance drivers. Preferred certifications: CRCS – Certified Revenue Cycle Specialist (AAHAM), CRCR – Certified Revenue Cycle Representative (HFMA), and Lean Six Sigma Black Belt (LSSBB), CSPR – Payment & Reimbursement, CSBI – Business Intelligence, CSPPM – Physician Practice Management (all HFMA), and PMP (PMI). 
  

Required Skills: 

• Expertise in client governance, escalations, and executive-level communication 
  

• Strong knowledge of automation/AI in RCM (BOTs, analytics, PMS optimization) 
  

• Deep understanding of compliance standards (HIPAA, ISMS, QMS, payer regulations) 
  

• Exceptional leadership, strategic planning, and organizational development skills 
  

• Ability to influence and collaborate across executive, client, and cross-functional teams. 
  

• Deep understanding of reimbursement trends, payer regulations, and revenue optimization strategies.
  

Performance Metrics: 

• Financial Outcomes – Achieve departmental revenue targets with margins planned levels and deliver year-on-year cost optimization 5%. 
  

• RCM KPIs – Maintain collections 95%, AR aging <25 days, denials 6%, and clean claim rate 99% across practices. 
  

• Operational Efficiency – Improve AHT vs. FTE utilization by 10% annually through workforce planning and process optimization. 
  

• Client Governance – Ensure 95% client retention, 4.5/5 satisfaction scores, and on-time contract renewals.