Manager, RCM Financial Analysis
Medsuite Inc
Job Level
Mid-LevelSenior
About the role
- Supervise day-to-day Appeals operations and ensure SLA adherence for Inpatient and Outpatient claims.
- Review and analyse denied claims, identifying root causes and ensuring effective appeal strategies.
- Manage a team of Appeals taskers, providing guidance, coaching, and performance feedback.
- Ensure appeals are drafted and submitted with accurate clinical and administrative justification.
- Monitor productivity and quality benchmarks and implement corrective actions where needed.
- Act as an escalation point for complex appeal cases requiring advanced expertise.
- Track key metrics (turnaround time, success rate, appeal overturn percentage) and report performance to leadership.
- Contribute to process improvements and automation initiatives to enhance efficiency and accuracy.
Requirements
- 5–7 years of RCM experience, with at least 2–3 years in Appeals.
- Strong exposure to both Inpatient and Outpatient Appeals is mandatory.
- Proven experience in managing or leading a team in the RCM domain.
- Strong analytical, problem-solving, and decision-making abilities.
- Excellent communication skills (verbal and written) to coordinate with clients and internal teams.
- Prior experience as a Team Lead/Assistant Manager in Appeals within a US RCM company.
- Proficiency with RCM tools, EMR/EHR systems, and payer portals.
- Ability to manage high-volume workflows and prioritise under pressure.
