RCM Ops & Quality Manager I, Claims Submission

Job Description:

The RCM Operations & Quality Manager I manages and provides oversight to RCM global partner teams with complex assignments and escalations related to their RCM department. The incumbent ensures that daily, weekly, and monthly tasks are accomplished effectively and in a timely manner. They assist with the onboarding and training of new employees and actively lead performance-based initiatives for clients. Additionally, they monitor the quality of work performed by Specialists and Level 1 managers, author standard operating procedures (SOPs), and serve as a key RCM subject matter expert within RCM Managed Services and other departments.

• Provide advanced guidance to employees and Global Partners on client and company expectations.
• Oversee the onboarding and training process, providing ongoing feedback on global partner performance. 
• Act as a primary liaison between global partner/vendor team members and management. 
• Ensure departmental procedures are documented and SOPs remain accurate and current according to client and industry policies/regulations.
• Handle and resolve escalations that Specialist/Global teams cannot address, escalating to functional manager when appropriate.
• Lead discussions with clients regarding current performance, trends, and updates.
• Conduct regular performance meetings with departmental employees and global partner vendors.
• Collaborate with management teams to identify and quantify potential issues and implement remediation plans in a timely manner.
• Ensure service level agreements (SLAs) and productivity requirements are met in relation to functional area performance, resolution of tasks, and client inquiries.
• Foster and maintain positive working relationships with internal and external customers by providing superior customer service.
• Ensure adherence to best practice setups, policies, and procedures, providing recommendations for improvement.
• Proactively identify and avoid compliance issues.
• Ensure continuity of RCM department services when global partners and/or assigned staff are not available.
• Perform other duties that support the overall objective of the position.

Education Required:  

• Bachelor's Degree in Finance, Accounting, or Healthcare related discipline. 
• Or, any combination of education and experience which would provide the required qualifications for the position.

Experience Required:

• 5+ years of experience in revenue cycle management.
• 3+ years of vendor/partner management and/or client management.

Knowledge, Skills & Abilities:

• Knowledge of: Practice management systems; customer service best practices; Revenue Cycle Management principles, theories, and best practices; laws, regulations, policies, and procedure governing the functional area; Microsoft Office Suit; Windows-based programs.
• Skill in: Effective communication with cross-functional team members, peers, and management; providing customer service to internal and external clients; problem solving, analytical, and critical thinking; working as member of a team; communicating clearly, concisely, and effectively; establishing and maintaining effective working relationships.
• Ability to: Build strong internal and external relationships; work independently with limited direction and/or guidance; maintain confidential information; work in a fast-paced environment; stay organized, prioritize workload, multi-task, and meet deadlines.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the company reserves the right to change this job description and/or assign tasks for the employee to perform, as the company may deem appropriate.

NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.