🎁 Before you apply, rehearse this interview. Create your free WorkMundi account and get an Interview Training on HelpsYouSpeak — no cost, no card. I want my training →
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) .