Vice President - RCM Operations - US Healthcare

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Role Summary:
The VP - Operations will lead end-to-end RCM operations for US healthcare clients from the Pune delivery center, overseeing billing, coding, AR follow-up, denial management, payment posting, and customer/client support.
This leader will drive operational excellence, P&L ownership, quality/compliance, team productivity, and client satisfaction while building scalable processes and capabilities for growth.
Key Responsibilities:
Operational Leadership:
- Own end-to-end RCM operations across the revenue cycle: patient access, prior authorization, coding, charge capture, billing, A/R follow-up, denial management, payment posting, and write-offs.
- Develop and execute the operations strategy for the Pune site, aligned with client SLAs and business goals.
- Ensure smooth coordination across functions (coding, billing, AR, denials, QA, training, and support) to optimize revenue and reduce leakages.
- Design and implement robust SOPs, workflows, and escalation matrices; continuously improve processes for efficiency and quality.
Performance & KPIs:
- Define, monitor, and improve key RCM KPIs such as:
1. Days in A/R, DSO, clean claim rate, denial rate, first-pass yield
2. Cash collections, A/R aging, old A/R reduction
3. Productivity, quality accuracy, TAT, and SLA adherence
- Build dashboards and reporting cadence for executive visibility and client reporting.

AR & Denial Management:
- Lead AR follow-up strategies across commercial/Medicare/Medicaid payers.
- Drive denial prevention and resolution programs, root cause analysis, and corrective action plans.
- Partner with coding, clinical, and billing teams to resolve medical necessity, coding, and documentation-related denials.
Client & Stakeholder Management:
- Serve as a key point of contact for client leadership; manage regular business reviews (QBRs/MBRs).
- Build strong relationships with providers, payers (as applicable), and internal stakeholders.
- Lead transition/onboarding of new accounts and ensure smooth handover into BAU operations.
People Leadership & Capability Building:
- Lead and mentor operations managers, supervisors, team leaders, and functional leads across coding, billing, AR, and denials.
- Build a high-performance culture with clear accountability, KPIs, and development paths.
- Drive training programs on RCM workflows, SOPs, compliance, and leadership capabilities.
Compliance, Risk & Quality:
- Ensure adherence to CMS, OIG, HIPAA, and payer-specific regulations across all RCM functions.
- Partner with Compliance and QA to manage audits, corrective action plans, and payer escalations.
- Implement internal controls around coding accuracy, claim submission, and documentation standards.
Financial & P&L Ownership:

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- Own P&L for the Pune site/vertical where applicable, including revenue, margin, utilization, and cost optimization.
- Drive productivity improvements, resource optimization, and technology-enabled automation to improve unit economics.
Required Experience:
- 15+ years of progressive experience in healthcare RCM, with at least 57 years in senior leadership (VP/Director/Sr. AVP) roles.
- Proven track record managing large, multi-functional RCM operations (voice + non-voice), including coding, billing, AR, and denials.
- Experience managing a delivery center/operations hub in India (Pune preferred) serving US healthcare clients.
- Deep understanding of US healthcare payers, coding systems (ICD-10, CPT, HCPCS), and denial arvlevers.
Required Skills:
- Strong operational leadership with ability to scale teams and processes.
- Strong financial acumen and ability to link RCM performance to business outcomes.
- Excellent client-facing and executive communication skills.
- Data-driven mindset with strong analytical, problem-solving, and change management skills.
- Hands-on capability to dive into claims, denials, authorizations, and coding issues when needed.
Preferred Qualifications:
- Bachelors degree in Healthcare Administration, Business, Finance, or related field; Masters preferred.
- Knowledge of PM/EHR systems (e.g., Epic, NextGen, Athena, eCW) and RCM tools.
- Experience in a BPO/ITeS/RCM outsourcing environment is highly desirable.
- Six Sigma, Lean, or other process improvement certifications.