Revenue Cycle Management (RCM) Subject Matter Expert | Permanent WFH

BizForce Healthcare is seeking an experienced Revenue Cycle Management (RCM) Subject Matter Expert (SME) to serve as a trusted internal expert supporting client implementations, operational performance, employee success, process improvement, and account growth.

This role requires extensive hands-on knowledge of the healthcare revenue cycle and the ability to translate complex client requirements into clear, scalable workflows, SOPs, staffing models, KPIs, training programs, and operational recommendations.

Key Responsibilities

Client Discovery, Implementation & Workflow Development

• Participate in discovery, training, and implementation activities for new clients, service lines, and complex RCM engagements.
• Assess client revenue cycle processes, systems, payer requirements, organizational structures, and performance expectations.
• Evaluate existing workflows to identify operational gaps, inefficiencies, risks, and improvement opportunities.
• Translate client requirements into clear operational processes and expectations for internal teams.
• Determine appropriate staffing requirements, skill sets, productivity expectations, quality standards, workflows, and technology needs.
• Serve as an RCM subject matter resource during client implementations, transitions, and escalations.
• Identify and mitigate potential implementation risks before they impact production or client satisfaction.
  
  

SOP, Playbook & Process Development

• Develop detailed RCM SOPs, playbooks, workflows, process maps, job aids, training materials, and reference guides.
• Convert client-specific knowledge and training into repeatable and scalable internal processes.
• Develop standardized and client-specific RCM playbooks.
• Document payer-specific processes, escalation procedures, system requirements, and client expectations.
• Establish quality assurance processes and operational controls.
• Continuously update documentation based on changes in client workflows, payer requirements, systems, and internal processes.
  
  

Accounts Receivable & Revenue Cycle Analysis

• Analyze aged Accounts Receivable (AR) reports to identify trends, risks, and financial opportunities.
• Evaluate AR by aging bucket, payer, financial class, denial category, provider, location, specialty, and other relevant factors.
• Identify root causes of aging AR, including denials, authorization issues, credentialing problems, coding errors, billing delays, documentation gaps, payer configuration issues, and workflow breakdowns.
• Assess collectability and prioritize AR opportunities based on financial impact and likelihood of recovery.
• Identify trends involving unpaid, underpaid, or incorrectly adjudicated claims.
• Develop actionable recommendations to improve collections, reduce aging, decrease denials, and improve revenue cycle performance.
• Translate RCM reports and financial data into practical operational actions for leadership and clients.
  
  

Payer, Contract & Reimbursement Expertise

• Review and interpret payer contracts, reimbursement exhibits, fee schedules, amendments, and related documentation.
• Understand reimbursement methodologies, timely filing requirements, appeal deadlines, authorization requirements, credentialing requirements, and payer policies.
• Identify contract provisions that may affect billing workflows, reimbursement, denials, or operational performance.
• Ensure payer requirements are appropriately incorporated into operational workflows.
• Identify potential reimbursement discrepancies and payer-related issues requiring further investigation or escalation.
• Provide RCM expertise to support payer strategy, contracting initiatives, and new service opportunities.
  
  

Credentialing & Enrollment

• Maintain working knowledge of provider credentialing, payer enrollment, recredentialing, and demographic maintenance processes.
• Assess how credentialing and enrollment issues affect claims, reimbursement, denials, and AR.
• Investigate issues involving provider effective dates, locations, taxonomy, NPI, TIN, payer configuration, and enrollment status.
• Partner with credentialing and operations teams to resolve reimbursement-impacting issues.
• Develop and improve credentialing and enrollment workflows, trackers, escalation procedures, and documentation.
  
  

New Hire & Production Support

• Provide RCM expertise and workflow support to new hires during training, implementation, and early production.
• Help employees understand both how a process works and why it matters within the overall revenue cycle.
• Identify knowledge gaps, coaching opportunities, workflow challenges, and potential role-fit concerns.
• Partner with Operations, Client Success, Recruitment, Training, and HR to improve employee readiness and reduce preventable early attrition.
• Distinguish between employee performance issues and challenges caused by inadequate training, unclear processes, system limitations, or client workflow issues.
• Provide technical RCM guidance when complex issues arise.
  
  

Operational Performance & Root-Cause Analysis

• Analyze client concerns related to productivity, quality, collections, denials, workflows, and employee performance.
• Conduct root-cause analysis to determine whether issues stem from staffing, training, processes, technology, payer requirements, or client workflows.
• Recommend practical solutions to improve efficiency, accuracy, productivity, and financial performance.
• Establish and recommend appropriate KPIs and performance standards for specific RCM functions.
• Assess whether productivity expectations are realistic based on workflow complexity and system requirements.
• Support operational leadership with complex RCM questions and escalations.
  
  

RCM Subject Matter Expertise

Provide Expertise Across Key Revenue Cycle Functions, Including

• Accounts Receivable follow-up
• Denial management
• Claims submission and corrections
• Payment posting
• Underpayment identification
• Eligibility and benefits verification
• Prior authorization
• Medical billing
• Coding-related workflows
• Charge entry and reconciliation
• Patient balances
• Insurance follow-up
• Appeals
• Payer correspondence
• Credentialing and enrollment
• Contract interpretation
• RCM reporting and analytics
  
  

Process Improvement, Technology & Automation

• Identify opportunities to streamline manual processes and eliminate unnecessary administrative work.
• Evaluate RCM workflows that may benefit from automation, AI, or technology-enabled solutions.
• Provide RCM expertise for automation and AI initiatives and validate solutions against real-world payer and billing requirements.
• Design workflows that effectively combine technology and human resources.
• Identify opportunities to standardize processes and best practices across multiple client accounts.
  
  

Scalability & Account Growth

• Build and maintain internal RCM knowledge to support the successful scaling of client accounts.
• Standardize best practices while maintaining necessary client-specific requirements.
• Partner with Client Success and leadership on strategic accounts with expansion opportunities.
• Support Sales and Client Success teams in evaluating prospective RCM opportunities.
• Participate in client discovery conversations when specialized RCM expertise is required.
• Help determine appropriate RCM resources, experience levels, workflows, and staffing models for prospective engagements.
• Identify additional services and operational opportunities for existing clients.
• Contribute to the development of new healthcare RCM service offerings based on recurring client needs.
  
  

Qualifications

• 7+ years of healthcare Revenue Cycle Management experience, with significant hands-on operational experience strongly preferred.
• Strong understanding of the end-to-end healthcare revenue cycle.
• Extensive experience with AR, denials, billing, claims follow-up, payment posting, eligibility, prior authorization, and payer workflows.
• Demonstrated ability to analyze aged AR and identify operational and financial trends.
• Experience reviewing or interpreting payer contracts, reimbursement methodologies, fee schedules, and payer policies.
• Working knowledge of healthcare credentialing and payer enrollment.
• Experience creating SOPs, playbooks, workflows, process documentation, training materials, job aids, and KPIs.
• Previous experience in RCM operations, implementations, training, team leadership, quality improvement, or process improvement.
• Strong analytical, critical-thinking, and root-cause analysis skills.
• Ability to distinguish between staffing, training, workflow, technology, and payer-related issues.
• Strong understanding of healthcare reimbursement and payer behavior.
• Comfortable working with reports, spreadsheets, AR data, operational metrics, and financial performance information.
• Ability to quickly learn new healthcare specialties, systems, payer requirements, and client workflows.
• Experience working directly with U.S.-based healthcare clients and senior leadership.
• Excellent written and verbal English communication skills.
• Ability to explain complex RCM concepts clearly to both technical and non-technical stakeholders.
• Experience in an offshore healthcare services, BPO, RCM, or remote staffing environment is strongly preferred.
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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Who are we

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.