Key Responsibilities

1. SOP Development & Governance

• Draft, author, and publish SOPs for all RCM functions: Charge Entry, Claims Processing, Payment Posting, AR Follow-Up, and Denial Management
• Conduct periodic SOP reviews (quarterly or upon policy/payer/client changes) and maintain strict version control
• Maintain and govern a centralized SOP repository accessible to operations and quality teams
• Facilitate SOP awareness and walkthrough sessions with floor teams and managers to ensure adoption
• Track SOP compliance through audits and flag deviations to operations leadership

2. Process Mapping & Workflow

• Create detailed swim lane flowcharts, process maps, and decision-tree diagrams for all RCM sub-processes
• Document current-state ('As-Is') and future-state ('To-Be') workflows
• Identify bottlenecks, handoff gaps, redundancies, and failure points within existing workflows
• Maintain a structured process library with all maps versioned and linked to corresponding SOPs
• Produce workflow visuals for leadership presentations, client onboarding packs, and audit readiness reviews

3. Automation Collaboration & BRD Drafting

• Collaborate with the RPA/automation team to translate manual RCM tasks into Business Requirement Documents (BRDs)
• Draft rule-based logic documents for bot development covering tasks such as claim status checks,

ERA/EOB posting, denial categorization, and eligibility verification

• Maintain an automation opportunity pipeline by identifying high-volume, rule-based, repetitive tasks across LOBs
• Support UAT (User Acceptance Testing) for automation deployments and provide operational sign-off from a process perspective
• Act as the process SME during bot design discussions, ensuring automation logic aligns with real-world operational workflows

4. Operational Standardization & Floor Support

• Partner with operations managers and teams leads to embed standard processes into day-to-day workflows
• Support new client onboarding by developing client-specific SOPs and customized process guides
• Participate in MBRs and QBRs to present process compliance status, improvement milestones, and open SOP gaps
• Provide process-level investigation support during client escalations or denial root cause analysis exercises
• Ensure all LOBs are operating on the latest approved SOPs and flag any deviation or workaround in use

5. Leadership Collaboration & Process Governance Reporting

• Work with AVP/VP and senior leadership to align process design with organizational strategy and client KPIs
• Prepare and maintain process health dashboards, SOP compliance trackers, and improvement initiative logs
• Support strategic programs such as denial reduction, TAT improvement, and AR aging reduction by delivering process-level insights and redesigned workflows
• Represent the Process Excellence team in cross-functional working groups and leadership alignment calls

Experience Requirements

• 3–6 years of total experience in RCM operations or RCM process-adjacent roles (training, quality, or process design)
• Minimum 1–2 years of hands-on SOP writing and/or process documentation experience in a healthcare BPO context
• Demonstrated ability to create process maps and workflows using Visio or equivalent tools
• Experience collaborating with automation or IT teams on workflow digitization or RPA projects is highly preferred
• Exposure to offshore delivery center environments supporting US-based healthcare clients
• Familiarity with EDI transactions (837, 835, 277CA) and payer portal operations

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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