RCM Manager (Revenue Cycle & Automation)

Position Title: RCM Manager

Department: Revenue Cycle Management & Insurance Operations

Reports To: Head of Operations

Employment Type: Full-Time Independent Contractor

Location: Remote (The Philippines or South Africa)

Working Hours: U.S. Business Hours Overlap Required

• The Philippines (PH): $1600 $2500 USD / month (Flexible up to $2500 USD / month for exceptional top 5% talent)
• South Africa (SA): $2300 $2800 USD / month

We are a venture-backed technology company building the next-generation banking and financial platform for the healthcare industry. By combining modern fintech infrastructure with deep healthcare operations we are solving complex financial bottlenecks for providers payers and patients.

Because claims processing revenue velocity and financial operations are core to our platform we are hiring a high-agency RCM Manager. Rather than building traditional high-headcount BPO teams our philosophy is to hire elite operational leaders who can own end-to-end revenue cycle performance while collaborating closely with our product and engineering teams (including our software engineering group in Brazil) to build refine and automate core RCM workflows.

This is not a traditional manual medical billing management role. We are looking for an experienced Revenue Cycle Management (RCM) Manager who understands the full life cycle of U.S. healthcare claims payer adjudication mechanics and financial clearinghouse operations.

In this role you will lead the operational integrity of our revenue cycle processesoverseeing complex claims processing denial resolution payment posting and patient/provider financial workflows. Crucially you will act as a strategic bridge between operations and technology: identifying systemic billing bottlenecks documenting edge-case payer rules and collaborating directly with engineers to automate repetitive RCM steps into scalable software workflows.

• End-to-End RCM Oversight: Manage day-to-day operations across eligibility verification charge capture claim submission payment posting clearinghouse rejection management and accounts receivable (A/R) follow-up.
• Denials & Appeals Strategy: Analyze root causes of recurring claim denials across commercial (Aetna BCBS Cigna UHC) and government (Medicare/Medicaid) payers; develop standardized workflows and appeals playbooks to maximize collection yields.
• Clearinghouse & Payer Management: Monitor ERA/835 and EDI 837 transaction flows resolve clearinghouse errors and maintain strong operational alignment with partner clearinghouses and commercial payers.

• Product & Tech Feedback Loop: Document manual operational workarounds payer-specific edge cases and systemic adjudication delays to assist software engineers in building automated API connections rules engines and AI-driven workflows.
• Process Optimization & SOP Architecture: Design document and refine scalable Standard Operating Procedures (SOPs) as our financial platform scales across healthcare verticals.

• RCM Analytics: Track and report on core KPI metrics including Days in A/R Clean Claim Rate Net Collection Rate First-Pass Resolution Rate and Denial Rates.
• HIPAA & Financial Compliance: Ensure 100% adherence to HIPAA rules secure PHI handling and healthcare billing compliance standards.

• Healthcare RCM Leadership: 5 years of direct experience in U.S. healthcare Revenue Cycle Management with 2 years in a team lead supervisory or management role.
• Top-Tier Background: Proven track record within a high-performing U.S. Healthcare BPO a fast-growing digital health startup or a tech-enabled medical billing organization.
• Technical RCM Knowledge: Deep domain mastery of CPT ICD-10 HCPCS modifier usage CMS-1500/UB-04 forms 837/835 EDI transactions and clearinghouse operations (e.g. Change Healthcare Availity Waystar).
• HIPAA Training: Certified or thoroughly versed in HIPAA regulatory compliance and secure PHI management.

• Analytical & Data-Driven: Exceptional problem-solving skillsable to dissect complex payer denial patterns and leverage data to optimize financial performance.
• Automation-Minded Builder: Tech-forward mindset. You actively seek to eliminate repetitive manual work through software integration rather than adding more manual steps.
• Communication: Flawless verbal and written English with executive-level clarity when communicating with internal founders software teams and external healthcare partners.