- Design and implement RCM infrastructure including eligibility verification, prior authorization, and claims submission.
- Architect a digital-first, automated revenue cycle for clinical and DME services.
- Integrate clearinghouses, EHR/practice management systems, and payer APIs.
- Define Clean Claim baseline and documentation standards.
- Automate prior auth, clinical documentation, and denial management using AI/ML.
- Define and instrument core RCM KPIs including first-pass resolution and days in AR.
- Serve as internal subject matter expert on payor policy and regulatory changes.
- Maintain HIPAA compliance.
- Recruit and lead a high-performing RCM team.
HIPAA