Senior Manager, Revenue Cycle Management, Provider Operations
New
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Oscar HealthHealth insurance
This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remoteFull-TimeManager
SalaryThe base pay for this role is: $122,212 - $160,404 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
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Job Details
- Experience
- 7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations; 3+ years of experience leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes.
Requirements
- 7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations.
- 3+ years leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes.
- Advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements.
- Experience developing and executing revenue cycle strategies that improve coding accuracy, claims performance, reimbursement, and financial outcomes.
- Experience with coding and clinical documentation integrity, including provider documentation review, provider queries, and pre- and post-bill review processes.
- Ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations.
- Experience leading complex cross-functional initiatives with clinical, operations, finance, compliance, credentialing, and other stakeholders.
- Strong executive communication skills to communicate complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership.
- Bonus: CPC, CCS, CCS-P, CPMA, or comparable coding/revenue cycle certification.
- Bonus: Experience leading or overseeing coding professionals and/or certified coders.
- Bonus: Experience in a multi-state medical group, telehealth organization, or complex healthcare delivery environment; provider and payer environments; risk-adjustment coding; credentialing and payer enrollment; or external revenue cycle, coding, or billing vendor management.
Responsibilities
- Own the strategy and performance of OMG's revenue cycle function, including professional billing, coding, claims management, denials, eligibility, documentation, and related workflows.
- Serve as the senior subject matter expert for coding and billing, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, and payer requirements.
- Establish and monitor revenue cycle KPIs and controls, using data and root-cause analysis to improve clean claims, coding accuracy, reimbursement, denial rates, and financial performance.
- Lead coding and documentation integrity strategies, including pre- and post-bill review, provider queries, addendums, signatures and co-signatures, and provider education.
- Lead denial prevention and resolution strategies by identifying systemic trends and partnering across teams on corrective actions.
- Partner with clinical leadership on ICD-10/HCC documentation and coding to identify opportunities for accurate capture of clinically supported diagnoses.
- Evaluate payer-specific performance, requirements, and coding considerations, and develop strategies for reimbursement, eligibility, claim edits, and denials.
- Partner with Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders to resolve complex revenue cycle issues and support new programs and services.
- Develop scalable revenue cycle policies, workflows, governance, and vendor oversight for a growing, multi-state provider organization.
- Advise OMG leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies; lead complex initiatives through implementation and measurement.
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