Manager, Revenue Cycle Operations
Listing location: USFull-TimeManager
Salary100,000 - 130,000 USD per year
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Job Details
- Experience
- 8+ years of progressive revenue cycle experience, including at least 5 years in leadership or strategic RCM operations roles.
- Required Skills
- LeadershipTableauMicrosoft ExcelCross-functional collaborationProcess improvementEHR
Requirements
- 8+ years of progressive revenue cycle experience, including at least 5 years in leadership or strategic RCM operations roles.
- Proven experience managing multi-state or multi-payer billing, coding, and claims operations.
- Strong knowledge of payer policies, denial management, provider enrollment, and claims adjudication workflows.
- Experience with capitation, value-based care models, encounter reconciliation, and quality reporting (e.g., HEDIS).
- Hands-on expertise with enterprise EHR systems (Athenahealth or similar), including claims optimization and workflow automation.
- Strong analytical skills with proficiency in Excel, Tableau, and claims data interpretation tools.
- Certified Professional Coder (AAPC or AHIMA required), with additional certifications (CPPM, CPCO, CHFP) preferred.
- Experience in pediatric, primary care, or behavioral health coding strongly preferred.
- Lean Six Sigma or process improvement certification (preferred).
- Strong leadership, communication, and cross-functional collaboration skills with a focus on accountability and results.
Responsibilities
- Lead end-to-end billing and coding operations across fee-for-service, capitation, and hybrid payment models, ensuring clean and compliant claims submission.
- Monitor daily claims workflows, denials, and edits while serving as escalation point for complex payer and coding issues.
- Track and analyze key RCM KPIs such as AR days, clean claim rate, denial rate, and encounter reconciliation, providing insights to leadership.
- Support capitation and value-based care operations, including encounter reconciliation, risk adjustment, and quality measure capture (e.g., HEDIS).
- Partner with Clinical, Product, Credentialing, and Compliance teams to ensure readiness across markets and payer systems.
- Lead and develop billing and coding teams, driving accountability, performance management, and continuous improvement.
- Own SOPs, workflows, and process optimization initiatives to improve scalability, automation, and operational efficiency.
- Collaborate with Product and IT teams to enhance system performance, automation tools, and claims infrastructure.
- Ensure audit readiness and compliance with CMS, OIG, and payer requirements through structured governance and documentation.
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