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The Revenue Cycle Manager will be responsible for managing the full revenue cycle, including intake, insurance verification, coding, billing, claims processing, accounts receivable (A/R), collections, and patient/provider financial services. This role requires a strong understanding of prescription providers, payer contract management, medical policy interpretation, and healthcare reimbursement processes. The ideal candidate will bring leadership experience, operational expertise, and a passion for building efficient, compliant, and patient-focused billing operations.
Key Responsibilities:
Revenue Cycle Operations
- Lead and manage the end-to-end revenue cycle process.
- Oversee medical billing, coding, claim submissions, denial management, appeals, and collections to ensure timely and accurate reimbursement.
- Ensure clean claims and timely claim submission in accordance with payer-specific guidelines.
- Monitor key performance indicators (KPIs) such as days in A/R, denial rates, collection rates, and first-pass resolution rates.
- Ensure compliance with all applicable laws, regulations, and payer guidelines.
Prescription Provider & Contract Management
- Collaborate with prescription providers and pharmacies to ensure billing and reimbursement processes align with provider requirements and payer policies.
- Review and manage payer contracts, identify opportunities for renegotiation, and ensure reimbursement rates are optimized.
- Interpret and apply insurance medical policies to support accurate claim submission and minimize denials.
People & Office Management
- Lead and mentor a team of billing specialists, intake coordinators, and revenue cycle staff.
- Manage team workflows, prioritize tasks, and implement best practices to streamline operations.
- Conduct regular performance reviews and training sessions to maintain a high-performing team.
- Oversee patient onboarding and insurance verification processes to ensure complete and accurate demographic and payer information.
- Ensure patient communications around billing, benefits, and financial responsibilities are handled professionally and empathetically.
- Support resolution of escalated billing issues and inquiries.
Qualifications:
- Bachelor's degree in Healthcare Administration, Business, or related field (required); Master's preferred.
- Minimum of 5–7 years of experience in healthcare revenue cycle management, including medical billing, coding, and collections.
- Proven experience managing a team in a medical billing or healthcare finance environment.
- Strong knowledge of CPT, HCPCS, ICD-10 coding, payer guidelines, and insurance requirements.
- Familiarity with prescription provider workflows, payer policy management, and prior authorization processes.
- Experience with electronic medical records (EMR) and billing systems.
- Excellent leadership, organizational, and interpersonal skills.
- Strong analytical and problem-solving abilities.
Seniority level
- Seniority levelMid-Senior level
Employment type
Job function
- Job functionAccounting/Auditing and Management
- IndustriesMedical Equipment Manufacturing and Manufacturing
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