01Overview
Role & responsibilities
Operations Leadership
- Lead and manage end-to-end DME Revenue Cycle Management operations across multiple clients and business units.
- Develop and execute operational strategies aligned with organizational objectives.
- Ensure achievement of key performance indicators related to revenue, collections, productivity, quality, and service delivery.
- Drive continuous process improvement and operational excellence initiatives.
- Oversee workforce planning, capacity management, and resource optimization.
- Establish governance frameworks to monitor operational performance and business outcomes.
Revenue Cycle Management
- Oversee Insurance Verification, Benefits Investigation, Prior Authorization, Intake, Billing, Payment Posting, Denial Management, Appeals, and AR Follow-up functions.
- Improve clean claim rates and reduce claim rejections and billing errors.
- Drive reductions in AR aging and outstanding inventory.
- Ensure timely reimbursement and cash flow optimization.
- Analyze payer-specific trends and implement corrective action plans.
- Develop revenue recovery strategies for denials, underpayments, and aging accounts.
Client Relationship Management
- Act as the executive point of contact for strategic DME clients.
- Conduct Executive Reviews, Quarterly Business Reviews (QBRs), and governance meetings.
- Ensure delivery against contractual obligations, KPIs, and SLAs.
- Build long-term client partnerships and drive client retention initiatives.
- Manage escalations and ensure timely resolution.
- Identify opportunities to expand services and grow existing client relationships.
Financial Management
- Own the P&L; for the DME Billing business unit.
- Drive revenue growth, profitability, and operational efficiency.
- Develop and manage departmental budgets, forecasting, and financial plans.
- Monitor business performance against revenue and margin targets.
- Identify automation and cost optimization opportunities to improve ROI.
- Drive year-over-year improvements in revenue and profitability.
Compliance & Risk Management
- Ensure compliance with:
- HIPAA Regulations
- CMS Guidelines
- Medicare Requirements
- Medicaid Regulations
- Commercial Payer Policies
- Internal Audit Standards
- Drive audit readiness and compliance governance initiatives.
- Establish robust controls to mitigate operational and regulatory risks.
- Ensure adherence to documentation standards and data security policies.
Leadership & Talent Development
- Lead large teams consisting of Directors, Associate Directors, Senior Managers, Managers, and Operations Leaders.
- Build leadership pipelines and succession planning frameworks.
- Drive employee engagement, retention, and performance management initiatives.
- Mentor senior leaders and foster a high-performance culture.
- Develop training and capability-building programs across operations.
Process Excellence & Transformation
- Lead digital transformation and automation initiatives.
- Drive Lean Six Sigma and continuous improvement programs.
- Implement workflow optimization and productivity enhancement projects.
- Evaluate emerging technologies, automation tools, and vendor solutions.
- Improve scalability, quality, and operational efficiency through innovation.
Business Growth & Innovation
- Partner with Business Development and Sales teams to support growth initiatives.
- Participate in RFP responses, solution design, and client presentations.
- Identify current revenue streams, service offerings, and market opportunities.
- Support client onboarding, transitions, and business expansion projects.
- Build scalable operational frameworks to support future growth.
Desired Candidate Profile
Mandatory Requirements
15+ years of experience in US Healthcare Revenue Cycle Management.
Extensive leadership experience in DME Billing Operations.
Minimum 8+ years in senior leadership roles such as Director, Senior Director, AVP, or VP.
Proven experience managing large-scale DME Revenue Cycle operations.
Strong expertise in:
- DME Billing
- Insurance Verification
- Prior Authorization
- Accounts Receivable Management
- Denial Management
- Payment Posting
- Medicare & Medicaid Billing
- Revenue Optimization
- Client Management
Demonstrated ability to manage P&L; and drive business profitability. Strong experience leading operational transformation and automation initiatives.
Proven success managing strategic client relationships and executive-level stakeholders.
Educational Qualification
UG: Bachelor's Degree (Mandatory)
PG: MBA / MHA / Any Postgraduate Degree (Preferred) .
