Senior Manager, Revenue Cycle Management, Provider Operations

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OscarHealthcare insurance

This is a remote position, open to candidates who reside in: Atlanta, GA.Full-TimeManager

Salary122,212 - 160,404 USD per year

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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.

Have 7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations.
Have 3+ years of experience leading revenue cycle programs, teams, or functions with operational and/or financial accountability.
Have advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements.
Have experience developing and executing strategies to improve coding accuracy, claims performance, reimbursement, and financial outcomes.
Have experience with coding and clinical documentation integrity, provider documentation review, provider queries, and pre- and post-bill review.
Be able to analyze complex revenue cycle data, identify trends and root causes, and turn findings into actionable strategies and recommendations.
Have experience leading complex cross-functional initiatives with clinical, operations, finance, compliance, credentialing, and other stakeholders.
Have strong executive communication skills for presenting revenue cycle performance, risks, opportunities, and recommendations to senior leadership.
Preferred: CPC, CCS, CCS-P, CPMA, or comparable coding/revenue cycle certification.
Preferred: Experience overseeing coding professionals or certified coders, risk-adjustment coding, credentialing and payer enrollment, or external revenue cycle vendors.

Own the strategy and performance of the revenue cycle function, including professional billing, coding, claims management, denials, eligibility, documentation, and related workflows.
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 billing reviews, provider queries, addendums, signatures, and provider education.
Lead denial prevention and resolution strategies, identifying systemic trends and coordinating corrective actions.
Partner with clinical leadership on ICD-10/HCC documentation and coding to support accurate capture of clinically supported diagnoses.
Evaluate payer 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 revenue cycle issues and support programs and services.
Develop scalable revenue cycle policies, workflows, governance, and vendor oversight for a growing, multi-state provider organization.
Advise leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies; lead initiatives through implementation and measurement.

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