Group Manager- Healthcare operations

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