Introduction

A career in IBM Consulting embraces long-term relationships and close collaboration with clients across the globe. In this role, you will work for IBM BPO, part of Consulting that, accelerates digital transformation using agile methodologies, process mining, and AI-powered workflows.

You'll work with visionaries across multiple industries to improve the hybrid cloud and AI journey for the most innovative and valuable companies in the world. Your ability to accelerate impact and make meaningful change for your clients is enabled by our strategic partner ecosystem and our robust technology platforms across the IBM portfolio, including IBM Software and Red Hat.

Curiosity and a constant quest for knowledge serve as the foundation to success in IBM Consulting. In your role, you'll be supported by mentors and coaches who will encourage you to challenge the norm, investigate ideas outside of your role, and come up with creative solutions resulting in groundbreaking impact for a wide network of clients. Our culture of evolution and empathy centers on long-term career growth and learning opportunities in an environment that embraces your unique skills and experience. 

Role Overview

The Operations Leader – US Healthcare RCM will head large-scale offshore delivery operations from India supporting US provider groups, hospitals, MSOs, or RCM clients. The role is accountable for operational excellence, client satisfaction, financial performance, compliance, and transformation initiatives across the end-to-end revenue cycle.

This position requires deep expertise in US payer systems, offshore governance models, SLA management, and global stakeholder engagement.

Your Role And Responsibilities

End-to-End Offshore Delivery Ownership Oversee complete RCM functions delivered from India:

Front-End

Insurance eligibility & benefits verification
Prior authorization management
Patient demographic validation

Mid-Cycle

Medical coding (ICD-10-CM, CPT, HCPCS)
Charge capture & charge entry
Documentation integrity coordination

Back-End

Claims submission (837P / 837I)
Payment posting (ERA/EOB)
AR follow-up (Commercial, Medicare, Medicaid)
Denial management & appeals
Patient collections & customer service
Copay billing & collections

Offshore Governance & Client Engagement

Act as primary India delivery leader for US clients.
Partner with US onshore leadership for seamless delivery.
Conduct Monthly/Quarterly Business Reviews (MBR/QBR).
Manage SLAs, KPIs, and contractual performance metrics.
Handle client escalations and compliance risks.

Payer & Regulatory Alignment

Ensure Operational Alignment With US Payer Requirements Including

Centers for Medicare & Medicaid Services (CMS)

Maintain Compliance With

HIPAA & HITECH regulation
US billing and coding regulations
CMS reimbursement updates
PCI Compliance
Internal audit and quality frameworks

Financial & Operational Performance

Drive key RCM KPIs:
Days in AR
Net Collection Rate
AFL/TFL timelines
First Pass Resolution Rate
Denial Rate & Recovery Rate
Bad debt ratio and reserve
DSO
Cost per transaction
Optimize staffing models and capacity planning.
Improve margins through automation and productivity improvements.

Scale & Transformation Leadership

Lead large delivery teams (300–1500+ FTEs).
Drive automation (RPA, AI-assisted coding, workflow tools).
Standardize SOPs across specialties (Radiology, Cardiology, Behavioral Health, etc.).
Implement Lean / Six Sigma methodologies.
Support new client transitions and migrations from US to India.

Talent & Leadership Development

Build second-line leadership (Managers, Sr. Managers).
Establish training academies for coders and AR specialists.
Manage attrition, engagement, and performance culture.
Develop succession planning framework.

Talent & Leadership Development

Build second-line leadership (Managers, Sr. Managers).
Establish training academies for coders and AR specialists.
Manage attrition, engagement, and performance culture.
Develop succession planning framework.

Preferred Education

Master's Degree

Required Technical And Professional Expertise

Bachelor's degree in healthcare, Business, Finance, or related field.
15–20+ years of US Healthcare RCM experience.
5–10+ years leading large offshore teams.
Strong understanding of US Healthcare Regulatory
Experience managing multi-specialty RCM operations.

Preferred Technical And Professional Experience

CPC / CCS (AHIMA/AAPC)
Six Sigma Green/Black Belt
PMP (for transformation-heavy environments)
HFMA Certification

Key Competencies

Global stakeholder management
Offshore delivery governance
Financial acumen (P&L ownership)
Operational excellence
Data-driven leadership
Risk mitigation
Executive communication

Success Metrics

SLA adherence
10–20% YoY productivity improvement
Reduced denial rate
Improved DSO / Days in AR
Client CSAT
Margin expansion

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