Job Description:

Role Summary:

The VP - Operations will lead end-to-end RCM operations for US healthcare clients from the Pune delivery center, overseeing billing, coding, AR follow-up, denial management, payment posting, and customer/client support.

This leader will drive operational excellence, P&L ownership, quality/compliance, team productivity, and client satisfaction while building scalable processes and capabilities for growth.

Key Responsibilities:

Operational Leadership:

- Own end-to-end RCM operations across the revenue cycle: patient access, prior authorization, coding, charge capture, billing, A/R follow-up, denial management, payment posting, and write-offs.

- Develop and execute the operations strategy for the Pune site, aligned with client SLAs and business goals.

- Ensure smooth coordination across functions (coding, billing, AR, denials, QA, training, and support) to optimize revenue and reduce leakages.

- Design and implement robust SOPs, workflows, and escalation matrices; continuously improve processes for efficiency and quality.

Performance & KPIs:

- Define, monitor, and improve key RCM KPIs such as:

1. Days in A/R, DSO, clean claim rate, denial rate, first-pass yield

2. Cash collections, A/R aging, old A/R reduction

3. Productivity, quality accuracy, TAT, and SLA adherence

- Build dashboards and reporting cadence for executive visibility and client reporting.

AR & Denial Management:

- Lead AR follow-up strategies across commercial/Medicare/Medicaid payers.

- Drive denial prevention and resolution programs, root cause analysis, and corrective action plans.

- Partner with coding, clinical, and billing teams to resolve medical necessity, coding, and documentation-related denials.

Client & Stakeholder Management:

- Serve as a key point of contact for client leadership; manage regular business reviews (QBRs/MBRs).

- Build strong relationships with providers, payers (as applicable), and internal stakeholders.

- Lead transition/onboarding of new accounts and ensure smooth handover into BAU operations.

People Leadership & Capability Building:

- Lead and mentor operations managers, supervisors, team leaders, and functional leads across coding, billing, AR, and denials.

- Build a high-performance culture with clear accountability, KPIs, and development paths.

- Drive training programs on RCM workflows, SOPs, compliance, and leadership capabilities.

Compliance, Risk & Quality:

- Ensure adherence to CMS, OIG, HIPAA, and payer-specific regulations across all RCM functions.

- Partner with Compliance and QA to manage audits, corrective action plans, and payer escalations.

- Implement internal controls around coding accuracy, claim submission, and documentation standards.

Financial & P&L Ownership:

- Own P&L for the Pune site/vertical where applicable, including revenue, margin, utilization, and cost optimization.

- Drive productivity improvements, resource optimization, and technology-enabled automation to improve unit economics.

Required Experience:

- 15+ years of progressive experience in healthcare RCM, with at least 57 years in senior leadership (VP/Director/Sr. AVP) roles.

- Proven track record managing large, multi-functional RCM operations (voice + non-voice), including coding, billing, AR, and denials.

- Experience managing a delivery center/operations hub in India (Pune preferred) serving US healthcare clients.

- Deep understanding of US healthcare payers, coding systems (ICD-10, CPT, HCPCS), and denial arvlevers.

Required Skills:

- Strong operational leadership with ability to scale teams and processes.

- Strong financial acumen and ability to link RCM performance to business outcomes.

- Excellent client-facing and executive communication skills.

- Data-driven mindset with strong analytical, problem-solving, and change management skills.

- Hands-on capability to dive into claims, denials, authorizations, and coding issues when needed.

Preferred Qualifications:

- Bachelors degree in Healthcare Administration, Business, Finance, or related field; Masters preferred.

- Knowledge of PM/EHR systems (e.g., Epic, NextGen, Athena, eCW) and RCM tools.

- Experience in a BPO/ITeS/RCM outsourcing environment is highly desirable.

- Six Sigma, Lean, or other process improvement certifications.