Manager of Revenue Cycle Operations

Position Summary

The Manager of Revenue Cycle Operations is responsible for overseeing operational performance across core revenue cycle functions to ensure accurate claim submission, compliant billing practices, timely reimbursement, and optimal financial performance. This role provides leadership and oversight across middle-cycle and back-end revenue cycle operations including charge entry, coding coordination, claim submission, billing, payment posting, denial management, patient collections, and revenue integrity initiatives. The Manager works collaboratively with clinical, operational, and finance leadership to improve reimbursement outcomes, operational efficiency, revenue capture, and overall financial performance.

Duties and Responsibilities

• Charge Entry & Coding Operations:
• Oversee charge capture and professional charge entry processes.
• Ensure coding accuracy and compliance with payer requirements.
• Monitor charge lag and support timely charge entry.
• Claim Submission & Billing:
• Oversee claim preparation, claim scrubbing, and submission workflows.
• Ensure claims are submitted timely and accurately according to payer guidelines.
• Monitor claim edits and system workflows to support clean claim submission.
• Payment Posting & Reconciliation:
• Oversee ERA and manual payment posting processes.
• Ensure payment reconciliation accuracy.
• Identify and escalate payer payment variances.
• Accounts Receivable & Denial Management:
• Manage insurance accounts receivable and denial resolution processes.
• Monitor payer trends and implement corrective actions to reduce denials.
• Support timely follow-up on unpaid claims.
• Patient Financial Services:
• Oversee patient balance collections and refund processes.
• Manage early-out vendors and bad debt placement processes.
• Ensure compliance with refund policies and patient financial regulations.
• Revenue Integrity:
• Monitor charge capture accuracy and revenue reconciliation.
• Identify revenue leakage and implement operational improvements.
• Support revenue cycle performance monitoring and reporting.

Vendor Management

• Percentage of Time Allocation: 50% Vendor Management / 50% Internal Revenue Cycle Operations
• Responsibilities:
• Serve as the primary point of contact and relationship manager for all outsourced Accounts Receivable vendors and business partners.
• Establish performance expectations, service level agreements (SLAs), and key performance indicators (KPIs) to ensure vendor accountability.
• Conduct regular vendor performance reviews focused on cash collections, aging reduction, denial resolution, productivity, quality, and turnaround times.
• Monitor and analyze AR vendor performance metrics, identifying trends, risks, and opportunities for improvement.
• Develop and execute action plans to reduce aged AR, improve collection rates, and accelerate cash flow.
• Ensure compliance with organizational policies, payer requirements, contractual obligations, and regulatory standards.
• Facilitate ongoing communication between internal stakeholders and vendors to resolve operational issues and remove barriers to performance.
• Review and approve vendor invoices, evaluate return on investment, and recommend staffing or outsourcing adjustments as needed.
• Provide executive-level reporting and recommendations regarding vendor performance, AR trends, and revenue cycle optimization opportunities.

Qualifications and Skills

• Education: Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field preferred.
• Professional Certification: Professional certification such as CPB, CPC, CRC or CHAM is preferred but not required.
• Experience:
• Minimum 5 years of experience in healthcare revenue cycle:
• Minimum 2 years of leadership or supervisory experience.
• Experience working in a physician practice or specialty clinic preferred:
• Experience with AthenaOne, NextGen, eClinicalWorks, or similar practice management systems preferred.
• Knowledge & Skills:
• Comprehensive knowledge of healthcare revenue cycle operations: including patient access, charge capture, billing, payment posting, accounts receivable, and patient financial services.
• Knowledge of payer reimbursement methodologies: including Medicare, Medicaid, and commercial insurance plans.
• Familiarity with CPT, HCPCS, and ICD-10 coding fundamentals and claim submission requirements:
• Familiarity with healthcare compliance requirements including HIPAA, documentation standards, and billing regulations.
• Strong analytical skills: with the ability to interpret revenue cycle performance metrics and operational data.
• Experience utilizing healthcare EMR and practice management systems (e.g., AthenaOne, eClinicalWorks, NextGen) and payer portals.
• Strong communication, collaboration, and problem-solving skills: to support cross-functional operational improvement.

Position Overview

• Benefits: Full benefits package active on day one.
• Type: Full-time, Remote position.