Description:

Role Summary:

- The Director of Pricing RCM Healthcare is a senior leadership role responsible for driving the pricing vision, strategy, and governance framework for all RCM products, solutions, and managed services.

- This position ensures pricing excellence through data-driven methodologies, competitive intelligence, margin optimization, and alignment with organizational growth objectives.

- The role requires deep expertise in RCM operations, US healthcare reimbursement models, payer-provider dynamics, and advanced pricing analytics.

Key Responsibilities:

Pricing Strategy & Governance

- Own the end-to-end pricing strategy, including pricing architecture, guardrails, discounting frameworks, and commercial policies for RCM offerings.

- Develop dynamic pricing models across service lines such as Coding, Billing, AR Follow-up, Denials Management, Payment Posting, and Provider Data Management.

- Translate market insights into competitive, profitable, and scalable pricing strategies aligned with business P&L goals.

- Establish pricing controls, periodic review processes, risk assessment frameworks, and compliance standards.

Market & Competitor Analysis

- Lead market intelligence programs to monitor pricing benchmarks, industry trends, regulatory updates, cost-to-serve fluctuations, and competitive shifts.

- Analyze customer behavior, buying patterns, volume trends, and service-level economics to predict pricing elasticity and optimize conversion.

- Benchmark internal pricing models with top RCM competitors, BPOs, and healthcare technology players.

Advanced Pricing Modelling & Analytics

- Build and maintain robust pricing models leveraging statistical methods, scenario planning, and margin simulation tools.

- Utilize RCM operational KPIs (productivity, quality, SLA adherence, staffing ratios) to calibrate accurate cost models.

- Partner with finance and analytics teams to ensure data accuracy, cost structures, forecast assumptions, and profitability analytics.

- Drive adoption of pricing automation tools, CPQ platforms, and predictive pricing engines.

Cross-Functional Leadership & Collaboration

- Partner with sales, solutioning, delivery, finance, marketing, and product teams to co-create client proposals, value propositions, and solution-based pricing.

- Support the sales team with pricing narratives, deal positioning, customer value calculations, and negotiation intelligence.

- Work closely with delivery and operations leaders to ensure pricing reflects operating realities and service-level economics.

- Serve as a trusted advisor to senior leadership on pricing strategy, market opportunities, and revenue optimization.

Deal Review & Commercial Decision Support

- Lead pricing review for large, strategic RCM deals including outsourcing contracts, T&M models, FTE-based pricing, platform-based pricing, outcome-based models, and hybrid constructs.

- Evaluate client contract requirements, risk profiles, SLAs, performance guarantees, and cost drivers to recommend optimal pricing strategies.

- Provide real-time pricing guidance for high-stakes negotiations and renewal strategies.

Management Reporting & Insights

- Present pricing insights, trend dashboards, and margin-impact analyses to senior leadership and executive committees.

- Drive pricing analytics reporting including win/loss analysis, pricing elasticity, profitability modelling, customer segmentation, and discount utilization.

- Establish standardized pricing documentation, repositories, and governance frameworks.

Required Skills & Competencies

- Deep understanding of US Healthcare RCM workflows, cost drivers, payer rules, CPT/ICD coding, reimbursement models, and compliance considerations.

- Strong command of pricing analytics, financial modelling, sensitivity analysis, and cost-to-serve modelling.

- Expertise in statistical tools and BI platforms (Excel Advanced, Power BI/Tableau, SQL, Python/R preferred).

- Proven success delivering pricing strategies in healthcare BPO, RCM operations, healthcare technology, or managed services environments.

- Ability to influence at senior levels, lead cross-functional stakeholders, and drive decisions in complex deal environments.

- Strong business acumen, negotiation skills, documentation capabilities, and executive communication.

Educational Qualifications

- Bachelors degree in Business, Finance, Economics, Healthcare Administration, Analytics, or related field.

- MBA or Masters in Analytics/Healthcare Management preferred