Job Profile Director – RCM Operations
Department
Revenue Cycle Management
Location
Hyderabad
Reporting to
Center Head
Hours of availability
Must, at minimum, be available to work eight (8) hours, Mondays-Fridays
(excluding company holidays) in alignment with typical USA working hours in at
least one of the following time zones: EST, CST, PST. Scheduling to be
supervised by, and in conjunction with, the Manager, Legal Operations
(Offshore).
Role Summary
The Director / Associate Director of RCM Operations will serve as the
strategic and operational leader for the firm’s end-to-end revenue cycle
functions and reports to the chief country executive (site head) with dotted
reporting to VP- Revenue Cycle Management in US. This role is responsible for
driving performance across Authorization, Billing, Coding, AR, and Denials
teams, ensuring compliance, productivity, and client satisfaction. The ideal
candidate will bring deep domain expertise in oncology RCM, a proven track
record in leading multi-tiered teams, and a passion for building scalable,
high-performing operations that support community oncologists and improve
patient outcomes. This is a high-impact leadership role at the heart of
oncology care delivery. You’ll shape the future of RCM operations, empower
community oncologists, and drive scalable, compliant, and efficient processes
that directly improve patient outcomes.
Key responsibilities
End-to-End Revenue Cycle Ownership
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Own and lead the full provider-side revenue cycle across physician billing
(CMS1500), spanning front-end, mid-cycle, and back-end operations — from
patient access and charge capture through coding, billing, AR follow-up, and
cash posting.
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Drive end-to-end revenue realization by ensuring seamless conversion of
clinical services into accurately captured, coded, billed, and collected
revenue across oncology, urology, and surgical practices.
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Build strong alignment between clinical teams, documentation, coding, and
billing functions to minimize revenue leakage and improve reimbursement
accuracy.
Physician Billing & Specialty Expertise
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Extensive experience in physician (CMS1500) billing within provider
organizations, with deep understanding of professional fee workflows and
revenue drivers.
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Strong familiarity with specialty-specific billing nuances, including:
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Oncology (infusion, drug administration, J-codes, radiation billing)
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Urology (procedural billing, diagnostics, in-office vs ASC workflows)
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Surgical services (global periods, modifiers, surgical coding and
reimbursement pathways)
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Ability to optimize charge capture, coding accuracy, and billing workflows
specific to specialty-driven revenue models.
Revenue Performance & Cash Optimization
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Manage large-scale AR portfolios with ownership of collections performance,
aging reduction, and overall cash realization across practices.
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Develop and execute structured strategies to improve:
- Net Collection Rate
- First Pass Yield (FPY)
- Days Sales Outstanding (DSO)
- Denial rates and rework volumes
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Drive sustained improvement in cash collections through prioritization
frameworks (high-value claims, aging-based follow-ups, payer segmentation)
and disciplined execution.
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Identify systemic revenue leakage across the cycle (front-end errors, coding
gaps, billing inefficiencies, AR backlog) and implement targeted fixes.
Operational Excellence & Workflow Transformation
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Optimize end-to-end RCM workflows to reduce cycle time, eliminate rework,
and improve throughput across coding, billing, and AR functions.
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Drive improvements in First Pass Yield by strengthening upstream processes
such as eligibility verification, authorization, documentation quality, and
coding accuracy.
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Standardize workflows across practices to ensure consistency in physician
billing operations across oncology, urology, and surgical service lines.
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Lead cross-functional process redesign initiatives to streamline handoffs
and reduce delays across coding → billing → posting → AR.
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Own and optimize workflows across all RCM functions: prior authorization,
charge entry, coding, payment posting, AR follow-up, and appeals.
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Ensure adherence to payer guidelines, CMS/NCCI/MAC regulations, and
oncology-specific protocols.
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Drive automation, SOP standardization, and cross-functional collaboration.
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Collaborate with clinical teams to resolve escalated reimbursement issues,
off-label drug usage, and documentation gaps.
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Lead initiatives to reduce denials, improve first-pass claim rates, and
enhance revenue realization.
AR Strategy & Collections Effectiveness
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Own AR performance across all aging buckets, including prioritization of
follow-ups, escalation handling, appeal strategies, and backlog reduction.
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Develop payer-specific and denial-specific strategies to improve recovery
rates and minimize revenue write-offs.
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Drive reduction in aged AR (particularly >90 days) through structured
interventions and performance governance.
Key Metrics / Success Outcomes
- First Pass Yield (CMS1500) ≥ 95%
- Charge Capture Accuracy ≥ 98%
- Charge Lag ≤ 48 hours
- Authorization turnaround time ≤ 48 hours
- Denial resolution rate ≥ 95%
- Billing accuracy ≥ 95%
- Coding compliance ≥ 98%
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Team productivity benchmarks met across all functions
- SOP adherence and audit compliance ≥ 99%
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Positive client satisfaction scores and stakeholder feedback
- Reduction in DSO across practices
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Sustained improvement in Net Collection Rate
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Reduction in AR >90 days and overall aging backlog
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Improved cash collections and reduced revenue leakage across specialties
Leadership Differentiator
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Acts as a true revenue owner — accountable for translating clinical activity
into financial outcomes by optimizing every step of the revenue cycle.
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Proven ability to build and scale high-performing provider RCM operations
with strong alignment between providers, documentation, coding, billing, and
AR teams.
Strategic Leadership & Team Oversight
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Lead and manage all RCM verticals including Authorization, Billing, Coding,
AR, Denials, and Payment Posting.
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Supervise a team of Managers and Supervisors across functions, ensuring
alignment with KPIs and organizational goals.
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Define and monitor performance metrics for accuracy, turnaround time, denial
resolution, and clean claim submission.
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Foster a culture of accountability, continuous improvement, and operational
excellence.
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Oversee hiring, onboarding, performance reviews, and career development for
mid-level leaders.
Compliance, Reporting & Governance
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Ensure HIPAA compliance, data confidentiality, and audit readiness across
all RCM functions.
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Stay current with industry trends, payer policy changes, and regulatory
updates impacting oncology RCM.
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Prepare and present monthly operational dashboards, audit summaries, and
client performance reports.
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Lead internal audits and support external compliance reviews as needed.
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Participate in coding governance, billing compliance, and client briefings.
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Establish robust performance tracking frameworks linking operational metrics
(FPY, denial rates, aging, charge lag) to financial outcomes (cash
collections, revenue realization, DSO).
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Lead regular reviews with clear accountability across teams to drive
continuous improvement in RCM performance.
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Translate operational insights into actionable strategies, including
resource allocation, workflow redesign, and prioritization of high-impact
initiatives.
Stakeholder Engagement & Client Partnership
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Serve as the primary liaison between RCM operations, clinical leadership,
and client stakeholders.
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Escalate systemic issues and propose data-driven solutions to executive
leadership.
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Represent the firm in strategic planning sessions, governance meetings, and
client reviews.
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Collaborate with US-based leadership to align offshore operations with
enterprise goals.
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Other duties assigned are to help drive our mission of improving the lives
of everyone living with cancer.
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Stay current with industry trends, changes to insurance policies, and other
developments that may impact on the collections process.
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Monitors and assesses business metrics to refine processes and improve
efficiencies including benchmarking.
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Prepare reports for clients and leadership related to performance and
productivity.
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Prepare payroll records and maintain employee attendance/audits for HR
payroll processing.
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Manage employee activity such as hiring, job performance, evaluations, and
disciplinary actions with appropriate approvals as required.
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Lead team meetings and prepare minutes for distribution to team and
management.
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Other duties as requested and assigned by management.
Qualifications
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18+ years of experience with 12+ years in US healthcare RCM, with 8+ years
in leadership roles.
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Prior GCC experience will be highly valued.
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Bachelor’s degree in Life Sciences, Pharmacy, Healthcare Administration, or
related field (Master’s preferred).
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Extensive knowledge of insurance payer guidelines and medical policies.
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Knowledge of ICD10, CPT and HCPCS codes required.
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Strong technical skills in Microsoft Office Suite (Word, Excel, PowerPoint).
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Proficiency in Epic, Aria, Cerner, 3M, Optum, Athena; Strong Excel and
dashboarding skills.
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Strategic thinker, team builder, operational optimizer, and client-facing
communicator.
- Six Sigma Certification preferred.