Business Operations Manager RCM

About AdvantixxRCM
AdvantixxRCM is a healthcare revenue cycle management company providing comprehensive medical billing, accounts receivable management, denial management, credentialing, payer enrollment, and revenue cycle solutions to healthcare providers.

We are seeking an experienced Operations Manager to lead the day-to-day operations of our growing RCM organization. This is a hands-on leadership position responsible for managing employees, workflows, client performance, productivity, quality, and operational results.

Position Summary

The Operations Manager is responsible for the overall daily operations of AdvantixxRCM and for ensuring that revenue cycle teams operate efficiently, accurately, and in compliance with company and client requirements.

The ideal candidate is an experienced healthcare operations leader who understands the complete medical revenue cycle and can independently manage teams, solve operational problems, analyze performance, develop processes, and hold employees accountable for results.

This position requires someone who can run the operation—not simply supervise employees.

Essential Responsibilities

Operations & Leadership

• Manage the day-to-day operations of AdvantixxRCM.
• Supervise medical billing, A/R, denials, payment posting, credentialing, eligibility, authorization, and administrative teams.
• Establish daily, weekly, and monthly operational priorities.
• Assign workloads and ensure appropriate staffing coverage.
• Monitor employee productivity, accuracy, attendance, and performance.
• Conduct team meetings, coaching sessions, and performance reviews.
• Identify staffing needs and participate in recruiting, interviewing, hiring, and onboarding.
• Develop supervisors and team leads as the organization grows.
• Address performance deficiencies and coordinate corrective action when necessary.
• Create an accountable, professional, results-driven work environment.
• Escalate significant operational, compliance, financial, or client matters to executive leadership.

Revenue Cycle Management

• Oversee the complete revenue cycle from charge entry and claim submission through final payment and account resolution.
• Monitor claim submission and clearinghouse activity.
• Monitor clean-claim and first-pass acceptance rates.
• Oversee insurance A/R follow-up.
• Monitor aging reports and develop strategies for reducing outstanding A/R.
• Oversee denial management, corrected claims, reconsiderations, and appeals.
• Monitor payment posting and reconciliation.
• Ensure claims are submitted and followed up within payer timely-filing requirements.
• Identify underpayments and reimbursement discrepancies.
• Monitor recurring payer issues and develop corrective strategies.
• Coordinate credentialing and payer enrollment activities.
• Work collaboratively with coding, eligibility, authorization, and billing teams.
• Identify revenue leakage and opportunities to improve collections.

Client Management

• Serve as an operational point of contact for assigned AdvantixxRCM clients.
• Oversee implementation and onboarding of new healthcare practices.
• Ensure contractual services and client expectations are met.
• Conduct client performance meetings when required.
• Review client A/R, collections, denials, and billing performance.
• Prepare and present operational reports.
• Respond to client concerns professionally and promptly.
• Coordinate resolution of escalated billing and reimbursement issues.
• Maintain strong client relationships and support client retention.
• Identify opportunities to improve or expand services.

Performance & Analytics

The Operations Manager will monitor key RCM performance indicators, including:

• Clean claim rate
• First-pass acceptance/resolution rate
• Denial rate
• Days in A/R
• A/R aging
• A/R over 90 days
• Net collection rate
• Claim submission turnaround
• Payment posting turnaround
• Denial resolution
• Appeal recovery
• Employee productivity
• Quality/accuracy
• Client performance
• Client satisfaction and retention

The Operations Manager is expected to use data to identify problems and implement measurable corrective actions.

Process Improvement

• Develop and maintain Standard Operating Procedures (SOPs).
• Standardize workflows across departments and clients.
• Identify inefficient processes and implement improvements.
• Establish quality-control procedures.
• Develop operational dashboards and reporting systems.
• Analyze denial and A/R trends to identify root causes.
• Implement corrective and preventive action plans.
• Assist leadership with automation and technology initiatives.
• Ensure employees are appropriately trained on new processes.

Compliance & Quality

• Maintain compliance with HIPAA and applicable privacy/security requirements.
• Ensure appropriate handling and protection of PHI.
• Promote compliant billing practices.
• Coordinate internal quality and billing audits.
• Ensure staff follow payer, client, and company requirements.
• Monitor employee access to EHRs, payer portals, clearinghouses, and other systems.
• Immediately escalate suspected billing irregularities, compliance concerns, privacy incidents, or material operational risks.

Qualifications

Required:

• Minimum 5 years of healthcare revenue cycle, medical billing, or healthcare operations experience.
• Minimum 2 years of supervisory or management experience.
• Strong understanding of the complete healthcare revenue cycle.
• Demonstrated experience managing medical billing and A/R operations.
• Experience with Medicare, Medicaid, Medicare Advantage, Medicaid Managed Care, and commercial insurance.
• Strong knowledge of CMS-1500 professional claims.
• Working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, EOBs, ERAs, CARC/RARC codes, and payer reimbursement processes.
• Experience with claim denials, appeals, corrected claims, and insurance follow-up.
• Experience working with clearinghouses and payer portals.
• Ability to interpret A/R aging and RCM performance reports.
• Strong leadership, organizational, analytical, and problem-solving abilities.
• Excellent written and verbal communication skills.
• Ability to manage multiple departments, priorities, and client accounts simultaneously.

Preferred Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Finance, or related field.
• CPC, CPB, CRCR, CCS, CHFP, or similar healthcare revenue cycle certification.
• Previous management experience within an RCM company or multi-practice medical billing organization.
• Experience managing remote and/or multi-location teams.
• Experience implementing new medical practices or RCM clients.
• Experience with credentialing and payer enrollment.
• Experience with multiple EHR/Practice Management systems and clearinghouses.
• Bilingual English/Spanish is a plus.

What We're Looking For

We are looking for a strong operator and leader who takes ownership.

The successful candidate should be able to identify a problem, investigate the root cause, develop a solution, assign responsibility, establish a deadline, and follow through until the issue is resolved.

This position is ideal for someone who is comfortable being held accountable for the performance of an entire RCM operation and who can successfully lead teams without requiring constant direction from executive leadership.

Originally posted on Himalayas