RCM Team Lead - Process Excellence
On-site · Pune, Maharashtra, India
Job Summary
RCM Team Lead responsible for SOP development and governance across RCM functions (Charge Entry, Claims Processing, Payment Posting, AR Follow-Up, Denial Management); lead process mapping of all sub-processes, create AS-IS and TO-BE workflows, identify bottlenecks and handoff gaps, and maintain a centralized, versioned SOP library. Lead automation collaboration by drafting BRDs and rule-based logic for bots (claim status checks, ERA/EOB posting, denial categorization, eligibility verification), support UAT, and act as process SME during bot design. Drive operational standardization, onboarding support with client-specific SOPs, participate in MBRs/QBRs to report compliance and improvement milestones, and provide investigation support during client escalations. Collaborate with AVP/VP and leadership to align process design with KPIs, deliver process health dashboards, and support strategic programs such as denial reduction, TAT improvement, and AR aging reduction. Represent the Process Excellence team in cross-functional groups and ensure all LOBs operate on the latest approved SOPs. This role requires 3–6 years in RCM, strong SOP writing experience in healthcare BPO, expertise in process mapping (Visio), plus collaboration with automation/IT teams and familiarity with EDI transactions and payer portals.
Required Qualifications
- 3–6 years of total experience in RCM operations or RCM process-adjacent roles (training, quality, or process design)
- Minimum 1–2 years of hands-on SOP writing and/or process documentation experience in a healthcare BPO context
- Demonstrated ability to create process maps and workflows using Visio or equivalent tools
- Experience collaborating with automation or IT teams on workflow digitization or RPA projects is highly preferred
- Exposure to offshore delivery center environments supporting US-based healthcare clients
- Familiarity with EDI transactions (837, 835, 277CA) and payer portal operations
- Visa sponsorship is not offered for this position
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