About this position
JOB TITLE: RCM Operations Manager (Billing + Credentialing Manager)
JOB SUMMARY
We are seeking an experienced RCM Operations Manager (Billing + Credentialing Manager) to oversee and optimize our end-to-end revenue cycle operations, including medical billing, claims management, denials/rejections, payment posting, patient balances, provider credentialing, and payer enrollment.
This role is responsible for driving revenue performance, ensuring regulatory compliance, maintaining accurate payer relationships, and leading a team to meet productivity and financial targets. The ideal candidate is highly organized, detail-driven, proactive, and comfortable building workflows, managing KPIs, and solving complex payer issues.
KEY RESPONSIBILITIES
Revenue Cycle Management (Billing & Collections)
- Oversee daily operations of billing, claims submission, claim edits, and follow-up.
- Monitor and improve clean claim rate, reduce rejections, and ensure timely submission of claims.
- Manage denial and rejection workflows, including appeals, corrected claims, and payer disputes.
- Ensure accurate payment posting, adjustments, and reconciliation to EOBs/ERAs.
- Oversee patient billing and collections processes (statements, follow-up, payment plans if applicable).
- Collaborate with clinical/front office teams to ensure documentation supports billing requirements.
Credentialing & Payer Enrollment
- Lead provider credentialing and re-credentialing for all payers (Medicare, Medicaid, commercial, networks).
- Manage CAQH profiles, payer applications, EFT/ERA setup, contract participation status, and provider demographic updates.
- Maintain credentialing calendar and ensure renewals are completed prior to expiration.
- Resolve payer enrollment delays and provide regular progress updates to leadership.
Compliance & Risk Management
- Ensure compliance with payer guidelines, billing regulations, HIPAA requirements, and internal policies.
- Support audits (internal/external), correct process issues, and implement corrective action plans.
- Maintain accurate documentation, tracking logs, and workflow SOPs.
Team Leadership & Performance Management
- Supervise billing and credentialing staff (or coordinate vendors) and ensure productivity goals are met.
- Train team members on workflows, payer rules, documentation requirements, and system processes.
- Assign workload, evaluate performance, coach staff, and participate in hiring decisions.
- Create and enforce standardized processes to reduce errors and improve turnaround times.
Reporting & KPI Management
- Track and report key performance indicators (KPIs), including:
- Days in A/R
- Denial rate and denial categories
- Net collection rate / gross collection rate
- First-pass acceptance / clean claim rate
- Charge lag and billing lag
- Credentialing turnaround time
- Prepare weekly/monthly RCM reports and recommend improvements based on data.
- Identify revenue leakage and implement strategies to improve cash flow.
System Optimization & Process Improvement
- Optimize billing system/EHR workflows, payer portals, clearinghouse settings, and automation tools.
- Develop standard operating procedures (SOPs), checklists, and internal controls.
- Lead implementation of improvements to support scalability and efficiency.
Requirements:REQUIRED QUALIFICATIONS
- 3–5+ years of RCM experience in healthcare billing and revenue cycle operations.
- 2+ years managing credentialing and payer enrollment processes.
- Proven experience managing staff or vendors in an RCM environment.
- Strong working knowledge of:
- Claims submission workflows (electronic and corrected claims)
- Denials management and appeals
- Eligibility verification, benefits, and authorizations (preferred)
- Medicare/Medicaid/commercial payer requirements
- EFT/ERA setup and payer portal management
- Familiarity with EHR/PM systems and clearinghouses.
- Strong organizational skills, attention to detail, and ability to meet deadlines.
PREFERRED QUALIFICATIONS
- Experience in home health, home care, DME, behavioral health, primary care, or multi-specialty clinics.
- Knowledge of CPT/ICD-10/HCPCS, modifiers, and medical necessity guidelines.
- Experience with Medicare/Medicaid revalidations and enrollment requirements.
- Certifications preferred: CPB, CPC, CBCS, or credentialing certification.
- Advanced Excel and reporting skills.
SKILLS & COMPETENCIES
- Strong leadership, accountability, and problem-solving mindset
- Excellent written and verbal communication
- Ability to build workflows and enforce compliance
- Comfortable working in fast-paced environments with multiple priorities
- High attention to detail and strong analytical decision-making
- Strong payer negotiation and follow-up skills
WHAT SUCCESS LOOKS LIKE IN THIS ROLE
- Clean claims submitted on time, with reduced rejections and denials
- Lower A/R days and stronger collections performance
- Credentialing and payer enrollments completed efficiently with proactive follow-up
- Accurate reporting and clear visibility into revenue performance
- A trained, efficient RCM team with structured workflows and SOPs