Manager, RCM Operations & Analytics

Performance Intelligence & Reporting

• Own standardized RCM KPI definitions, data sources, targets, controls, and reporting for key metrics such as days in accounts receivable (AR), AR aging, clean claim rate, first-pass resolution, denial and rejection rates, net collection rate, charge lag, and payment posting timeliness.

• Establish independent and timely visibility into transaction volumes, work queues, processing status, productivity, quality, and backlogs across internal teams and business process outsourcing (BPO) partners.

• Collaborate with Product, Engineering, Clearinghouse, and vendor teams to improve data access, reconciliation, accuracy, and reporting automation.

• Deliver actionable dashboards, operating reviews, trend analyses, root-cause findings, and recommendations at client, portfolio, and vendor levels.

• Identify at-risk clients, revenue leakage, denial patterns, and operational bottlenecks, and track corrective actions through to verified results.

• Operational Excellence & Process Improvement

  • Lead cross-functional improvement initiatives across charge capture, claims processing, denials, AR follow-up, payment posting, onboarding, and credentialing and enrollment handoffs.

  • Map current and future workflows, identify inefficiencies and rework, and partner with operations leaders to establish scalable processes and standard operating procedures.

  • Develop quality measurement and audit frameworks, analyze results, and recommend workflow or training improvements.

  • Measure onboarding performance and time-to-value for new RCM clients, including readiness, early production performance, and stabilization.

  • Manage improvement initiatives from business-case development through implementation, adoption, and validation of results.

  • Vendor & BPO Performance Management

    • Partner with the Vendor Manager to define, validate, and report vendor service-level agreements (SLAs), transaction volumes, productivity, turnaround times, accuracy, and quality measures.

    • Develop consistent vendor scorecards for weekly reviews and quarterly business reviews, using reconciled source data wherever possible.

    • Quantify performance gaps, recommend corrective actions, and monitor progress with vendor and operations stakeholders.

    • Support transaction forecasting, work allocation, staffing assumptions, vendor transitions, and contract negotiations through data-driven analysis.

    • Reconcile vendor invoices against contracted rates, eligible transaction types, and verified volumes, identifying discrepancies and potential savings.

    • Unit Economics, Capacity & Financial Performance

      • Build and maintain transaction-level cost models and unit economics by client, service, function, and BPO partner.

      • Track actual versus modeled vendor savings, cost-to-collect, service margins, and productivity in collaboration with Finance.

      • Develop capacity and throughput models to inform vendor allocation, staffing decisions, and backlog recovery plans.

      • Recommend opportunities to improve gross margin while protecting cash collections, service quality, and client experience.

      • Technology, Automation & Cross-Functional Partnership

        • Identify and prioritize automation, AI, workflow, and reporting opportunities that reduce manual work, improve first-pass yield, and increase operational visibility.

        • Translate operational needs into business requirements, support user acceptance testing (UAT), and measure benefits after deployment.

        • Analyze payer and clearinghouse edit performance and recommend improvements in collaboration with the teams responsible for technical rule ownership.

        • Partner with Service Management on client-facing insights, Finance on forecasts, and Sales and Implementation teams on demand planning and onboarding capacity.

        • Monitor payer policy and compliance-related trends, identify operational risks, and support process updates with relevant subject-matter experts.