COMPANY OVERVIEW:
AGS Health is more than a revenue cycle management company — we're a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider's revenue cycle operations. AGS Health leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics —all made possible with college-educated, trained RCM experts. AGS Health employs more than 12,000 team members globally and partners with more than 130 clients across a variety of care settings, specialties, and billing systems.
For more details, please visit http://www.agshealth.com
You can also visit us at https://www.linkedin.com/company/ags-health
Job Title: Behavioral Health Consultant / SME- Revenue Cycle Management (RCM) – US Healthcare
Location: US
Role Type: Contractual
Experience: 8–12+ years in Behavioral Health RCM
Role Summary
We are seeking a highly experienced Behavioral Health Revenue Cycle Management (RCM) Subject Matter Expert (SME) with deep expertise in US healthcare. The role will be responsible for designing SOPs, standardizing processes, and training offshore (India-based) teams across the end-to-end revenue cycle, specifically within Behavioral Health services.
The ideal candidate will bring strong domain knowledge, operational excellence, and training capability to build a high-quality, scalable RCM function.
Key Responsibilities
1. RCM Process Expertise (Behavioral Health)
- Serve as SME for end-to-end Behavioral Health RCM:
- Patient Access & Eligibility Verification
- Benefits & Authorization Management
- Charge Capture & Coding (ICD-10, CPT, HCPCS – relevant to Behavioral Health)
- Claims Submission (professional & institutional)
- Denial Management & Appeals
- Payment Posting & Reconciliation
- AR Follow-ups (Commercial, Medicare, Medicaid, Managed Care)
- Ensure compliance with US regulations, payer rules, and Behavioral Health-specific nuances (e.g., parity laws, telehealth billing, substance abuse treatment billing).
2. SOP Development & Process Standardization
- Develop, document, and maintain detailed SOPs, process maps, and work instructions for all RCM functions.
- Establish standardized workflows across clients and teams.
- Drive process optimization, automation opportunities, and best practices.
- Ensure SOPs are audit-ready and aligned with compliance standards (HIPAA, payer guidelines).
3. Training & Capability Building (India Team)
- Design and deliver comprehensive training programs for offshore teams:
- New hire onboarding
- Process-specific training
- Refresher sessions and upskilling
- Create training materials, manuals, and assessment frameworks.
- Conduct quality calibration sessions with operations and QA teams.
- Act as a mentor to team leads and managers.
4. Transition & Knowledge Transfer
- Lead process transitions from onshore to offshore.
- Conduct detailed knowledge transfer sessions with stakeholders.
- Ensure smooth ramp-up with minimal disruption to operations.
5. Quality, Compliance & Performance Improvement
- Define KPIs and SLAs for RCM operations.
- Partner with QA teams to improve accuracy, productivity, and turnaround times.
- Identify root causes of denials and revenue leakage; implement corrective actions.
- Support internal and external audits.
6. Stakeholder Management
- Collaborate with US clients, providers, payers, and internal leadership.
- Act as a trusted advisor to clients on RCM strategy and improvements.
- Provide insights into financial performance, trends, and optimization opportunities.
Required Qualifications
- Bachelor’s degree in Healthcare Administration, Life Sciences, or relevant field (Master’s preferred).
- 8–12+ years of experience in US Healthcare RCM.
- Minimum 3–5 years of hands-on experience in Behavioral Health billing and RCM.
Strong understanding of:
- Behavioral Health billing workflows
- Payer-specific rules and denial patterns
- Coding standards (CPT, ICD-10, DSM relevance)
- Experience in creating SOPs and training delivery for offshore teams.
Preferred Skills
- Certifications such as CRCR, CPC, or HFMA (preferred).
- Strong analytical and problem-solving skills.
- Excellent communication and presentation abilities.
- Proven experience managing cross-functional and global teams.
Key Competencies
- Process excellence mindset
- Training & coaching capability
- Attention to detail and compliance focus
- Stakeholder management
- Continuous improvement orientation
Success Metrics
- SOP completeness and adoption rate
- Training effectiveness (assessment scores, ramp-up time)
- Reduction in denial rates and AR days
- Improvement in collections and net revenue realization
- Team productivity and quality scores
Why Join
- Opportunity to build and scale Behavioral Health RCM capability
- High visibility role with client interaction
- Leadership impact in offshore capability building
Shift:
- 10 hour shift
- 8 hour shift
- Day shift
- Evening shift
Experience:
- Behaviour Health : 3 years (Required)
- RCM: 5 years (Required)
- Training: 1 year (Preferred)
Work Location: Remote
