Revenue Cycle Manager
New
P
Pacific Health GroupHealthcare revenue cycle
Remote – California BasedFull-TimeManager
Salary85,000 - 90,000 USD per year
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Job Details
- Experience
- Minimum of five (5) years of progressive experience in healthcare revenue cycle management, medical billing, reimbursement, coding, healthcare finance, or a related field.
- Required Skills
- Microsoft ExcelEHRHIPAA
Requirements
- Minimum of five years of progressive experience in healthcare revenue cycle management, medical billing, reimbursement, coding, healthcare finance, or a related field.
- Previous supervisory or management experience within Revenue Cycle operations.
- Demonstrated experience managing billing, claims, accounts receivable, collections, denials, appeals, and reimbursement processes.
- Strong working knowledge of ICD-10, CPT, HCPCS, modifiers, and healthcare billing practices.
- Strong understanding of managed care reimbursement, payer requirements, claims adjudication, and payer contract administration.
- Knowledge of healthcare billing compliance requirements, HIPAA, and protection of PHI.
- Proficiency with healthcare billing platforms, EHR systems, reporting tools, and Microsoft Office Suite, particularly Excel.
- Ability to identify trends, conduct root-cause analysis, and implement corrective actions.
- Ability to lead teams, establish accountability, manage performance, and oversee complex workflows.
- Bachelor's degree in Healthcare Administration, Finance, Accounting, Business Administration, or a related field, or equivalent relevant experience may be considered.
- Preferred: CPC, CRCR, CRCP, or related credential.
- Preferred: Experience with Medi-Cal, California managed care organizations, or community-based healthcare programs such as ECM, Community Supports, CHW, or Behavioral Health.
Responsibilities
- Lead day-to-day Revenue Cycle operations and oversee billing, coding, claims submission, payment posting, accounts receivable, collections, denials, appeals, and reimbursement.
- Monitor outstanding, rejected, denied, unpaid, and underpaid claims through resolution and implement corrective action plans.
- Oversee accounts receivable and collections, review aging, and establish follow-up priorities to improve cash flow.
- Analyze denial trends, conduct root-cause analysis, and manage corrected claims and appeals through resolution.
- Serve as a primary Revenue Cycle contact for health plans and payers, reconciling claims and pursuing reimbursement discrepancies.
- Conduct audits and maintain compliance with payer requirements, healthcare billing regulations, HIPAA, contractual obligations, and organizational policies.
- Develop Revenue Cycle reports, dashboards, and performance analyses, and provide updates to the Directors of Community Health & Operations.
- Supervise, coach, train, and evaluate Revenue Cycle staff; establish performance expectations and monitor productivity and quality.
- Develop and maintain Revenue Cycle policies, procedures, workflows, and standard operating procedures.
- Collaborate with Finance, Quality Assurance, Operations, program leadership, and Information Technology to address operational and reimbursement issues.
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