Lead Service Operations Engineer

Lead Service Operations Engineer – Revenue Cycle Management (US Healthcare)

Role Summary

The Lead Service Operations Engineer – RCM is responsible for the stability, performance, and operational excellence of mission‑critical US healthcare Revenue Cycle Management applications. This role combines deep hands‑on operational expertise with team leadership responsibilities, acting as the primary SME for RCM platforms while mentoring engineers and driving service maturity.

The Lead ensures high availability of billing, claims, and reimbursement systems, applies ITIL best practices, and partners closely with business, vendors, and compliance teams to protect revenue and cash flow.

Key Responsibilities

Service Operations & RCM SME Ownership

• Act as the primary Subject Matter Expert (SME) for Revenue Cycle Management applications, workflows, and integrations.
• Oversee day‑to‑day operations for billing, claims, payment posting, denial management, and RCM reporting platforms.
• Ensure SLA adherence for revenue‑critical services, minimizing impact to billing cycles, payer submissions, and cash collections.
• Provide advanced operational support during peak periods such as month‑end, quarter‑end, and regulatory cutovers.
• Participate in 16/5 and weekend on‑call rotations, serving as escalation point for critical revenue incidents.

Incident, Problem & Change Management

• Lead major incident response for revenue‑impacting outages and performance issues.
• Troubleshoot complex, end‑to‑end RCM issues across claims, remittance (835), EDI (837), batch jobs, and interfaces.
• Perform and review root cause analysis (RCA) for recurring issues and drive permanent corrective actions.
• Assess revenue risk and provide input to change, patching, and release decisions affecting RCM systems.

Monitoring, Stability & Maintenance

• Oversee proactive monitoring of RCM applications and interfaces using Observability Tools.
• Define and tune alerts for revenue‑impacting failures such as claim backlogs, interface drops, and job failures.
• Plan and execute patching and maintenance activities aligned with billing cutoffs and financial close windows.
• Drive service reliability improvements through automation and operational optimization.

Compliance, Security & Access Management

• Ensure operational compliance with HIPAA, PHI, SOX, and US healthcare regulatory requirements.
• Review and govern access controls, vendor access, and segregation of duties for financial and patient data.
• Partner with security and compliance teams to remediate audit findings related to RCM operations.

Team Leadership, Mentoring & Coaching

• Lead, mentor, and coach a team of Service Operations Engineers supporting RCM platforms.
• Provide technical guidance, knowledge transfer, and hands‑on support for complex issues.
• Review incident handling, RCAs, and documentation produced by the team to ensure quality and consistency.
• Support onboarding, cross‑training, and skill development of team members in RCM and ITIL practices.
• Act as first‑level escalation and decision point for operational issues within the team.

Vendor & Stakeholder Collaboration

• Serve as the primary operations liaison with RCM vendors, clearinghouses, and third‑party partners.
• Coordinate payer rule changes, regulatory updates, upgrades, and production releases.
• Communicate incidents, risks, and service health to business and leadership in clear business‑impact terms.

Documentation & Continuous Improvement

• Own and maintain SOPs, KBAs, and runbooks for RCM operational processes.
• Track and review SLAs, MTTR, incident trends, and service KPIs.
• Identify opportunities for automation, standardization, and service improvement across RCM operations.

Required Skills & Experience

Technical & Domain Expertise

• Strong hands‑on experience supporting US Revenue Cycle Management systems.
• Deep understanding of claims lifecycle, EDI (837/835), clearinghouses, payer rules, and denial management.
• Proven experience supporting revenue‑critical healthcare applications in production environments.
• Strong foundation in ITIL Service Operations (Incident, Problem, Change, Major Incident Management).

Leadership & Communication

• Experience leading or mentoring support teams in a production operations environment.
• Ability to act as an RCM SME and provide guidance to engineers, vendors, and stakeholders.
• Strong communication skills with the ability to translate technical issues into business and revenue impact.
• Experience working with US‑based business teams in a follow‑the‑sun or global support model.

Preferred / Nice to Have

• Experience in healthcare financial systems, clearinghouse integrations, or large health systems.
• Exposure to automation, monitoring optimization, or operational analytics in RCM environments.
• ITIL certification or equivalent service management training.