Manager of Complex Issue Resolution – Revenue Cycle Management (RCM)

We are seeking a highly skilled and analytical Manager of Complex Issue Resolution to lead a specialized team dedicated to addressing escalated and intricate revenue cycle management (RCM) challenges that standard teams are unable to resolve. This role is pivotal in ensuring the seamless operation of our revenue cycle by effectively managing complex client issues, implementing process improvements, and enhancing overall client satisfaction.

Key Responsibilities:

• Team Leadership & Management:

• Lead and mentor a team of specialists focused on resolving complex RCM issues escalated from standard teams.

• Allocate resources efficiently to ensure timely and effective resolution of escalated cases.

• Conduct regular performance evaluations and provide ongoing training to enhance team capabilities.

• Complex Issue Resolution:

• Oversee the investigation and resolution of complex billing, coding, and reimbursement issues.

• Collaborate with cross-functional teams to identify root causes and implement corrective actions.

• Serve as the primary point of contact for clients regarding escalated RCM concerns, ensuring clear communication and resolution.

• Process Improvement & Compliance:

• Analyze patterns in escalated issues to identify systemic problems and areas for process enhancement.

• Develop and update standard operating procedures (SOPs) to prevent recurrence of complex issues.

• Ensure all resolutions comply with industry regulations and organizational policies.

• Stakeholder Collaboration:

• Work closely with standard RCM teams to provide guidance on complex cases and prevent future escalations.

• Communicate effectively with clients to manage expectations and provide status updates on issue resolution.

• Prepare and present reports to senior management on the status of escalated issues and team performance.

Key Performance Indicators (KPIs) and Targets:

1. Issue Resolution Time:

• Target: Resolve 95% of escalated issues within 10 business days.

2. First Contact Resolution Rate:

• Target: Achieve a 90% resolution rate on the first client contact for escalated issues.

3. Client Satisfaction Score:

• Target: Maintain a client satisfaction score of 4.5 out of 5 or higher for issue resolution.

4. Repeat Escalation Rate:

• Target: Limit repeat escalations to less than 5% of total cases.

5. Process Improvement Implementation:

• Target: Implement corrective actions for 100% of identified systemic issues within 30 days.

6. Compliance Adherence Rate:

• Target: Ensure 100% compliance with industry regulations and organizational policies in issue resolution.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, or a related field; Master’s degree preferred.

• Minimum of 5 years of experience in revenue cycle management, with at least 2 years in a supervisory role handling complex issues.

• In-depth knowledge of healthcare billing, coding, and reimbursement processes.

• Strong analytical and problem-solving skills with a track record of implementing effective solutions.

• Excellent communication and interpersonal skills, with the ability to manage client relationships effectively.

• Proficiency in RCM software and data analysis tools.

• Demonstrated ability to lead and develop high-performing teams.

Position Requirements

• Must have stable internet connection minimum of 5 MBPS

• Must have a mobile data plan as a backup

• Must be in a quiet environment

• Must be comfortable working the US business hours

• Must own a PC with at least 16 GB of memory

Why Join Us? We are a forward-thinking organization committed to excellence in revenue cycle management. In this role, you will have the opportunity to lead a critical team, tackle complex challenges, and drive significant improvements in our operations. If you are passionate about problem-solving and enhancing client satisfaction, we encourage you to apply.