RCM Performance Excellence Specialist

Key Responsibilities

• Serve as the primary RCM Performance Excellence point of contact for assigned practices, building trusted relationships with practice leadership and operational staff.
• Partner with Sr. Manager and lead recurring practice metric review meetings, presenting KPI performance, trend analysis, and actionable improvement recommendations.
• Translate centralized RCM strategies into practice-specific action plans, ensuring alignment between corporate objectives and local execution.
• Act as a conduit for practice feedback, surfacing operational pain points and opportunities to the Performance Excellence Sr. Manager and broader RCM leadership.
• Resolve live payer and reimbursement issues raised directly by practice leadership (e.g., a specific payer/CPT denial pattern such as allergy testing reimbursement), acting as the first point of contact before an issue is escalated.

Performance Analysis & Reporting

• Monitor and analyze key revenue cycle KPIs — including net collection rate, days in AR, denial rate, clean claim rate, and cash collections — at the practice and platform level.
• Develop and maintain performance dashboards, scorecards, and trend reports to provide real-time visibility into practice-level and cross-platform performance.
• Identify performance outliers and variances, conducting deep-dive analysis to determine root causes and recommend corrective actions.
• Prepare executive-ready summaries and presentations for leadership review, board reporting, and cross-functional stakeholder meetings.

Denial Root Cause Assessment & Mitigation

• Conduct structured denial root cause analyses to identify systemic issues across practices, payers, CPT codes, and denial categories.
• Partner with coding, billing, insurance AR, and patient access teams to develop and implement denial prevention and remediation strategies.
• Track denial trends over time, measuring the effectiveness of mitigation efforts and adjusting strategies as needed.
• Maintain current knowledge of payer policy changes, billing rule updates, and regulatory shifts that may impact denial patterns.

Cross-Practice Initiatives & Best Practice Dissemination

• Identify and champion cross-practice improvement opportunities by benchmarking performance across the SENTA portfolio.
• Contribute to working groups, workshops, and collaborative sessions to share best practices and standardize high-performing workflows.
• Support the design and rollout of new RCM policies, procedures, and process improvements across the practice network.
• Afford assistance in change management efforts tied to EMR transitions, new technology implementations, and operational transformation projects.

Continuous Improvement & Special Projects

• Apply process improvement methodologies (e.g., PDCA, Lean, root cause analysis) to drive sustainable performance gains.
• Support the Performance Excellence Sr. Manager on strategic initiatives, ad-hoc analyses, and project-based work as needed.
• Contribute to the development and refinement of performance excellence frameworks, playbooks, and standard operating procedures.
• Stay current on industry trends, benchmarks, and best practices in healthcare revenue cycle management.

Requirements

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field.
• 2-5 years of progressive experience in healthcare revenue cycle management, with demonstrated exposure to performance analytics, denial management, or practice operations.
• Strong analytical skills with proficiency in Excel (pivot tables, VLOOKUP, data modeling) and experience with reporting/BI tools.
• Pioneered ability to lead meetings, present data-driven insights, and influence operational change across diverse stakeholder groups.
• Solid understanding of healthcare billing - physician billing a significant plus, insurance AR workflows, coding fundamentals, and payer reimbursement methodologies.
• Excellent written and verbal communication skills with the ability to translate complex data into clear, actionable narratives.
• Self-starter with the ability to manage multiple priorities and work independently in a fast-paced, multi-practice environment.

Preferred Experience

• Working within a Management Services Organization (MSO), private equity-backed healthcare platform, or multi-site physician practice group.
• Familiarity with ENT and/or Allergy specialty billing, including immunotherapy and ancillary services.
• Experience with eClinicalWorks (eCW), Modernizing Medicine (ModMed), or comparable EMR/PM systems.
• Exposure to process improvement frameworks (Lean, Six Sigma, PDCA).
• Certifications such as AAHAM (CRCS/CRCE), HFMA (CRCR), or similar RCM credentials.