Job Family:

Travel Required:

Clearance Required:

What You Will Do:

• Should be able to manage a team of 15 to 20 FTE’s.
• Ensure seamless day-to-day operations with consistent delivery against productivity, quality, and SLA targets.
• Monitor workflow, identify gaps, and implement timely corrective actions to maintain operational stability.
• Establish clear expectations, track individual and team performance, and provide structured coaching to drive results.
• Foster a culture of accountability, collaboration, and continuous performance improvement.
• Maintain adherence to defined quality standards through regular audits and structured RCA/CAPA initiatives.
• Responsible for identifying production and quality issues and putting plans in place for improvement as per the policy.
• Ensure compliance with established operational policies and procedures.
• Support effective denial resolution and contribute to AR optimization through timely follow-ups and issue identification.
• Analyse recurring denial trends and collaborate on corrective measures. Should review the inventory on daily basis and track inflow to make sure we are handling the inventory and allocation strategy done appropriately.
• Identify operational inefficiencies and support implementation of process improvements to enhance productivity and accuracy.
• Collaborate with internal stakeholders and support reporting, operational updates, and escalation management as required.
• Should be responsible for driving KPI Metrics, operational performance, process improvements, and stabilization.
• Will be responsible to resolve queries, account reviews and provide training in case required.
• Ensures daily update acknowledgements are sent promptly. Will be responsible to lead internal and external emails.
• Should work towards team engagement and retention/absenteeism.
• Should be good in Denial Management and should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials Ability to interact positively with team members, peer group and seniors.
• Demonstrated ability to exceed performance targets Ability to effectively prioritize individual and team
• Active involvement in project launch sessions to understand the Associates process and track the daily progress during the launch period.
• Communicates well in front of groups, both large and small.
• Identify inpatient/observation accounts requiring NOA (Notification of Admission)
• Submit notifications via payer portals, EDI, fax, or calls
• Initiate non-clinical authorizations where applicable
• Document reference / authorization numbers in the system

Scope & Boundaries:

Included:

• NOA submission
• Payer follow-up
• Documentation

Excluded:

• Clinical review / medical necessity
• Level-of-care decisions
• Appeals & physician advisor services

Account Exclusions (as per SOP):

• Medicare FFS
• Self-pay / charity
• Workers’ Compensation / liability
• Hospice / research
• Other payer-specific exclusions

Key KPIs:

• NOA Timeliness Compliance (%)
• First-Pass Submission Accuracy
• Denial Prevention Rate
• Productivity (Accounts/Day)
• Follow-Up Turnaround Time (TAT)

What You Will Need:

• Must have bachelor’s degree.
• 5+ Years’ experience in RCM
• Strong English Communication Skills (Oral and written) and Analytical Skills required for AR Calling for Medical Billing Process.

What Would Be Nice To Have:

• Superior problem-solving abilities
• Experience mentoring and training junior staffs.
• A flexible mindset to learn.
• Excellent detail-oriented skills and a highly reliable work ethic.
• Proficiency in Microsoft Office (Word, Outlook, Excel)
• Able to identify the automation opportunities for process betterment.
• Proactively identify risks, escalate issues, and support timely resolution

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.