About the RoleThe RCM Lead runs Baba's revenue cycle end to end. We bill Medicare and Medicaid for work rendered by our clinical team. Our payer mix is complex, and our patients are among the most vulnerable in the system, which makes collections harder than average and makes this role central to the business.
You will own eligibility, claim submission, follow-up, denials and appeals, cash posting, and reconciliation, along with payer enrollment and credentialing. You'll build the SOPs, run the team, and be the person who knows why any given claim didn't get paid. As we launch new service lines and revenue models, you'll stand up the billing and reconciliation workflows for those as well.
You'll report to the Head of Finance & Revenue Operations and work daily with Clinical Operations, Product & Engineering, and our payer contacts. This role is full-time and NYC-based; our office is in Soho.
Key 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 make sure documentation and time capture support the codes we bill, and feed back where upstream quality is causing 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 maintain CMS standards.
- Administer provider payment reconciliation in partnership with Finance, so what we pay clinicians and contractors ties to what was delivered.
- Partner with Product & Engineering to test and adopt automation and AI-assisted billing tools, giving concrete feedback on where they help and where they break.
We'd Love to Hear From You If- You have 5+ years in revenue cycle or medical billing, including 2+ years managing a billing team, ideally in a multi-payer environment with meaningful Medicare and Medicaid volume.
- You've owned end-to-end RCM metrics (clean claim rate, days in AR, denial rate) and can point to specific improvements you drove.
- You know the mechanics: claim submission, denial and appeal workflows, ERA reconciliation, payer enrollment and credentialing, and payer communications.
- You've built processes rather than just followed them, and you've done it in a company that was changing quickly.
- You've been on the receiving end of payer or CMS audits (TPE, RAC, MAC, UPIC, or commercial payer reviews) and won them: you know how to assemble documentation, respond on time, and run a billing operation so that an audit isn't scary.
- You are detail-oriented, organized, and see things through; nothing ages out on your watch.
- You are comfortable with new tools and want to shape how automation gets used in billing.
