Manager_Transition

<p><strong>About the Role</strong></p> <p>We are seeking an experienced <strong>RCM Manager</strong> to lead our Professional (CMS-1500) Billing operations across multiple specialties. This role owns end-to-end billing delivery for existing client accounts, drives <strong>new client/project implementations</strong>, and oversees <strong>EDI and ERA enrollment</strong> 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.</p> <p> </p> <p><strong>Key Responsibilities</strong></p> <p><strong>Operations & Team Management</strong></p> <ul> <li>Manage day-to-day operations of the professional billing team across multiple specialties and client accounts</li> <li>Set, monitor, and drive team performance against KPIs: clean claim rate, days in AR, denial rate, productivity, and quality/accuracy targets</li> <li>Conduct regular huddles, one-on-ones, and performance reviews; manage coaching, training, and PIPs as needed</li> <li>Own workforce planning, shift scheduling, and capacity/utilization management</li> <li>Build and maintain SOPs, training materials, and quality audit frameworks for the billing function</li> <li>Escalation point for complex claims, payer issues, and client escalations</li> </ul> <p><strong>New Project / Client Implementation</strong></p> <ul> <li>Lead billing workstreams for <strong>new client onboarding and transitions</strong>, from kickoff through go-live and stabilization</li> <li>Partner with Implementation, Credentialing, IT, and Coding teams to define timelines, dependencies, and readiness criteria</li> <li>Oversee PM/EHR system configuration validation, charge master setup, and fee schedule mapping relevant to billing</li> <li>Drive parallel billing runs, UAT, and go/no-go decisions for new accounts</li> <li>Identify workflow gaps and implement process improvements during and after transition</li> <li>Present implementation status, risks, and readiness updates to internal leadership and client stakeholders</li> </ul> <p><strong>EDI & ERA Enrollment Oversight</strong></p> <ul> <li>Own the <strong>EDI enrollment</strong> function across payers and clearinghouses, ensuring timely completion and tracking</li> <li>Oversee <strong>ERA (835) / EFT enrollment</strong> processes, ensuring accurate payer setup for electronic payment posting</li> <li>Manage relationships and escalations with clearinghouse partners (e.g., Availity, Waystar, Change Healthcare, Office Ally, Trizetto)</li> <li>Review and approve enrollment trackers; ensure SLAs for enrollment turnaround are met</li> <li>Troubleshoot systemic EDI/ERA issues impacting claim transmission or payment posting across accounts</li> </ul> <p><strong>Reporting & Stakeholder Management</strong></p> <ul> <li>Prepare and present operational dashboards and MBRs/QBRs to internal leadership and clients</li> <li>Analyze denial trends, AR aging, and root causes; drive corrective action plans</li> <li>Ensure compliance with HIPAA, payer regulations, and internal quality standards</li> <li>Act as primary liaison between the billing team, client stakeholders, and internal support functions (Credentialing, Coding, IT, AR/Denials)</li> </ul> <p> </p> <p><strong>Required Qualifications</strong></p> <ul> <li>