RCM Consultant – Medical Billing & Process Development

We are seeking an experienced RCM Consultant for a 3-month contract to establish, organize, and optimize our Medical Billing and Revenue Cycle Management operations. The consultant will review current workflows, define standardized processes, develop comprehensive SOPs, improve departmental coordination, structure the sales process, and assist in building the right team through recruitment and hiring. This role requires hands-on involvement in process development, team structuring, sales optimization, and training to ensure scalable and efficient operations.

Key Responsibilities

RCM Process Development:
Analyze existing Medical Billing and RCM operations to identify gaps, bottlenecks, and inefficiencies. Define end-to-end RCM workflows including eligibility verification, charge entry, coding, claim submission, payment posting, AR follow-up, denial management, and reporting. Establish clear processes, responsibilities, approval flows, and escalation procedures. Set KPIs and performance benchmarks for various RCM functions and develop a scalable operating structure to support future growth.

SOP Development:
Create detailed Standard Operating Procedures for all major RCM activities. Document step-by-step workflows for each department and role, defining quality standards, productivity targets, escalation protocols, and reporting requirements. Develop SOPs covering client onboarding, account setup, billing operations, AR and denial management, quality assurance, reporting, and client communication. Ensure documentation facilitates efficient training and onboarding.

Department & Team Structure:
Evaluate the current organizational setup and recommend an appropriate departmental structure with clear reporting hierarchies. Define roles, responsibilities, KPIs, and required skill sets for each position. Assess manpower needs based on client volume and operational demands. Establish coordination and handover processes between departments to ensure smooth operations.

Sales Process Development:
Review and enhance the existing medical billing sales process. Define the complete sales workflow from lead generation and qualification through discovery, proposal, negotiation, onboarding, and client conversion. Develop structured communication processes targeting doctors, physicians, practice owners, and healthcare decision-makers. Create sales SOPs, scripts, qualification questions, follow-up procedures, and CRM workflows. Bridge gaps between Sales and Operations by establishing a seamless handover process post-sale.

Recruitment & Hiring:
Assess current team capabilities and identify hiring needs. Develop job descriptions, responsibilities, required skills, and KPIs for RCM roles. Participate in screening and technical interviews for candidates with expertise in US healthcare billing, AR, denials, claims, coding, and payer processes. Assist management in selecting and closing suitable candidates. Help standardize recruitment and onboarding processes for new hires.

Training & Implementation:
Train management and operational teams on new processes. Conduct knowledge-transfer sessions for department heads and key staff. Ensure SOPs are actively implemented and not just documented. Monitor initial rollout and adjust as needed. Establish a training framework for future employees.

Management Reporting & KPIs:
Define KPIs for RCM, Sales, QA, AR, and related departments. Develop reporting formats and management dashboards. Set performance measurement standards for individuals and teams. Recommend tracking methods for productivity, quality, collections, denials, AR aging, sales pipeline, conversions, and client retention.

Required Qualifications

- Minimum 10 years of experience in US Medical Billing and Revenue Cycle Management, preferably in senior management, consulting, or operational leadership roles.
- Deep understanding of the full US healthcare RCM lifecycle.
- Proven track record in building or restructuring RCM processes and departments.
- Strong expertise in SOP development and process documentation.
- Experience working with medical billing companies, healthcare providers, physicians, or practice owners.
- Solid knowledge of RCM sales and client acquisition strategies.
- Comfortable engaging directly with doctors and healthcare decision-makers.
- Skilled in recruitment, technical interviewing, team building, and hiring within RCM.
- Excellent leadership, communication, analytical, and problem-solving abilities.
- Ability to work independently and deliver measurable results within a 3-month timeframe.

Contract Terms

Position: RCM Consultant
Industry: US Medical Billing / Healthcare RCM
Contract Duration: 3 Months
Engagement Type: Project-Based / Consultancy
Primary Objective: Develop and implement a scalable RCM operating structure, SOP framework, sales process, and recruitment system.
Compensation: Rs200,000 to Rs500,000 per month
Work Location: In person

This is an excellent opportunity for a seasoned RCM professional to lead critical operational improvements and build a foundation for sustainable growth within a dynamic healthcare environment.