Vice President - Revenue Cycle Management Operations - Healthcare

About the job:

Vice President - Operations (Revenue Cycle Management)

Role Summary:

The Vice President Operations will lead end-to-end Revenue Cycle Management (RCM) operations for US healthcare clients from the Pune delivery center. This role will oversee billing, coding, accounts receivable (AR) follow-ups, denial management, payment posting, and client support functions. The incumbent will be responsible for driving operational excellence, owning P&L, ensuring quality and compliance, enhancing team productivity, and delivering high client satisfaction while building scalable processes to support business growth.
Key Responsibilities:
- Own end-to-end RCM operations including patient access, prior authorization, coding, charge capture, billing, AR follow-up, denial management, payment posting, and write-offs.
- Develop and execute operational strategies aligned with client SLAs and organizational objectives.
- Ensure seamless coordination across coding, billing, AR, denials, QA, training, and support functions to optimize revenue realization and minimize leakages.
- Design and implement robust SOPs, workflows, and escalation matrices; drive continuous process improvements.
Performance & KPIs:
- Define, monitor, and improve key RCM metrics such as Days in AR, DSO, clean claim rate, denial rate, first-pass yield, cash collections, AR aging, and old AR reduction.
- Track productivity, quality accuracy, turnaround time (TAT), and SLA adherence.
- Develop dashboards and reporting frameworks for leadership visibility and client reporting.
AR & Denial Management:
- Lead AR follow-up strategies across commercial, Medicare, and Medicaid payers.
- Drive denial prevention and resolution through root cause analysis and corrective action plans.
- Collaborate with coding, clinical, and billing teams to address medical necessity, coding, and documentation-related denials.
Client & Stakeholder Management:
- Act as the primary point of contact for client leadership; lead regular business reviews (QBRs/MBRs).
- Build and maintain strong relationships with providers, payers, and internal stakeholders.
- Oversee transitions and onboarding of new clients, ensuring smooth integration into operations.
People Leadership & Capability Building:
- Lead and mentor operations managers, team leaders, and functional heads across coding, billing, AR, and denials.
- Foster a high-performance culture with clear accountability, defined KPIs, and career development pathways.
- Drive training initiatives on RCM workflows, compliance, SOPs, and leadership development.
Compliance, Risk & Quality:
- Ensure adherence to CMS, OIG, HIPAA, and payer-specific regulations.
- Partner with compliance and QA teams to manage audits, corrective action plans, and escalations.
- Implement internal controls for coding accuracy, claims submission, and documentation standards.
Financial & P&L Ownership:
- Own P&L for the Pune operations/vertical, including revenue, margins, utilization, and cost optimization.
- Drive productivity improvements, resource optimization, and automation initiatives to enhance unit economics.
Required Experience:
- 15+ years of progressive experience in healthcare RCM, with at least 5-7 years in senior leadership roles (VP/Director/Sr. AVP).
- Proven experience managing large, multi-functional RCM operations (voice and non-voice), including coding, billing, AR, and denial management.
- Experience managing delivery centers in India (Pune preferred) serving US healthcare clients.
- Strong understanding of US healthcare payers, coding systems (ICD-10, CPT, HCPCS), and denial management levers.
Required Skills:
- Strong operational leadership with the ability to scale teams and processes.
- Solid financial acumen with the 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 capabilities.
- Hands-on expertise in claims, denials, authorizations, and coding processes.
Preferred Qualifications:
- Bachelors degree in Healthcare Administration, Business, Finance, or a related field; Masters preferred.
- Familiarity with PM/EHR systems such as Epic, NextGen, Athena, or eClinicalWorks.
- Experience in BPO/ITeS or RCM outsourcing environments is highly desirable.
- Certifications in Six Sigma, Lean, or other process improvement methodologies are a plus.