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RCM Lead

Baba Care· Operations
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New YorkFull-timePosted 2mo ago

About the role

The RCM Lead is responsible for Baba's end-to-end revenue cycle management, including eligibility, claim submission, follow-up, denials and appeals, cash posting, reconciliation, payer enrollment, and credentialing. Leads billing operations, develops SOPs, manages the billing team, partners with Clinical Operations and Product & Engineering on automation, and ensures audit readiness.

Responsibilities

  • Own the full claim lifecycle for Medicare and Medicaid billing: eligibility verification, prior authorization where required, claim submission via our clearinghouse, follow-up, denial management, appeals, cash posting, and ERA reconciliation.
  • Track and drive the core RCM metrics: clean claim rate, days in AR, denial rate and overturn rate, and collection lag by payer. Report on them weekly and be able to explain every movement.
  • Own payer enrollment and credentialing for our clinicians and entities, and maintain payer-specific billing rules, fee schedules, and adjudication quirks.
  • Build and maintain SOPs for every RCM workflow, and manage and coach the billing team, assigning work, reviewing quality, and holding the team to the SOPs you write.
  • Partner with Clinical Operations to ensure documentation and time capture support the codes we bill, and provide feedback on upstream quality impacting downstream denials.
  • Resolve patient-facing billing questions and payer-side escalations with a patient-first, de-escalating approach.
  • Own audit readiness and response for billing: maintain documentation standards that meet CMS standards.
  • Administer provider payment reconciliation in partnership with Finance, aligning clinician/contractor payments with delivered services.
  • Partner with Product & Engineering to test and adopt automation and AI-assisted billing tools, providing feedback on effectiveness and limitations.

Qualifications

  • 5+ years in revenue cycle or medical billing, including 2+ years managing a billing team, ideally in a multi-payer environment with Medicare/Medicaid volume.
  • Experience owning end-to-end RCM metrics (clean claim rate, days in AR, denial rate) and driving improvements.
  • Knowledge of claim submission, denial/appeal workflows, ERA reconciliation, payer enrollment/credentialing, and payer communications.
  • Experience building processes in rapidly changing environments.
  • Experience with payer or CMS audits (TPE, RAC, MAC, UPIC, or commercial payer reviews) and successful audit outcomes.
  • Detail-oriented, organized, and able to see initiatives through to completion.
  • Comfort with new tools and interest in shaping automation use in billing.

Skills

Required:Revenue cycle managementPayer enrollment and credentialingSOP development and team management
Last updated Sep 17, 2026. Interested? Apply on the company site.

About Baba Care

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