Senior Manager, RCM Optimization & Strategy

InStride HealthHealthcare revenue cycle

Location: Remote, USFull-TimeManager

Salary130,000 - 145,000 USD per year

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Job Details

Experience: 6+ years of progressive healthcare revenue cycle management experience, with at least 3 years in an analytical, optimization, or process improvement capacity.

Have 6+ years of progressive healthcare revenue cycle management experience, including at least 3 years in an analytical, optimization, or process improvement capacity.
Hold a bachelor’s degree in Healthcare Administration, Finance, Business Analytics, or a related field, or have 10+ years in healthcare RCM.
Demonstrate experience using complex data sets to streamline RCM operations, reduce claim denials, and recover lost revenue.
Bring project management experience leading cross-functional technology or process improvement projects.
Have working knowledge of insurance payor policies, billing guidelines, and claims submission requirements.
Be familiar with CPT and ICD-10 codes and their impact on billing and reimbursement.
Have hands-on experience with payor contract analysis, fee schedule audits, and underpayment identification and recovery.
Have experience configuring billing platforms; experience with Apero, Sigma, Mahler, or similar RCM software is preferred.
Demonstrate analytical and problem-solving skills, attention to detail, and the ability to communicate complex revenue cycle data as actionable insights.
Build effective relationships across clinical, operational, and technical teams.

Analyze end-to-end RCM workflows to reduce manual processes, operational bottlenecks, and revenue leakage.
Configure billing systems, payor billing logic, fee schedules, contract terms, and internal and clearinghouse rules.
Build and refine RCM KPI dashboards, including clean claim rate, denial rate, days in AR, claim lag, appeals, and collection rate.
Audit billing engine rules and fee schedules for alignment with payor guidelines and coding updates.
Lead root-cause analyses of claim denials and underpayments and recommend durable fixes.
Review escalated claims to confirm internal checks and appeal pathways are complete before issues go to payors.
Partner with technology teams to implement automation for claim submission, denials management, and revenue capture.
Coordinate with Payor Operations, Licensing & Credentialing, Authorization & Eligibility, Patient Access, and Clinical Operations to address claims issues.
Lead change management for billing tools, software integrations, and workflow changes, including team training and support.
Provide RCM insights, progress updates, and financial performance reporting to RCM and executive leadership.

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