RCM & Compliance Manager

Job Summary

Ressen Health Care is seeking a results-driven RCM & Compliance Manager to lead and strengthen revenue cycle operations and regulatory compliance across our Nursing Home and Hospitalist divisions. This role is strategic and requires direct influence over revenue capture, documentation integrity, and care quality.

E&M Documentation & Compliance Oversight

• Conduct regular E&M documentation audits to ensure accuracy, completeness, and CMS guideline alignment.
• Identify documentation gaps, upcoding/downcoding trends, and provider-specific patterns requiring targeted education or corrective action.
• Develop and deliver provider training on E&M coding requirements, medical necessity standards, and documentation best practices for long-term care and inpatient encounters.
• Monitor regulatory changes related to E&M coding (including split/shared visit rules) and update internal compliance protocols accordingly.
• Lead and conduct care quality audits across nursing home facilities and hospitalist service lines, evaluating clinical documentation against established quality benchmarks.
• Collaborate with medical directors, nursing leadership, and clinical teams to translate audit findings into actionable improvement plans.
• Track and trend audit results over time, reporting outcomes to senior leadership with clear recommendations for operational and clinical improvements.
• Ensure audit processes meet or exceed CMS Conditions of Participation, state survey readiness standards, and internal quality benchmarks.

Revenue Cycle Management (RCM)

• Oversee and improve RCM workflows from claims submission through final adjudication, focusing on reducing denials and accelerating collections.
• Review and QA claims submissions for accuracy before release, ensuring proper coding, modifiers, and supporting documentation are in place.
• Lead denial management and appeals processes, conducting root cause analysis on denial trends and implementing systemic fixes to prevent recurrence.
• Monitor pending insurance claims and aging reports, driving timely follow-up and resolution of outstanding balances.
• Coordinate retrieval and follow-up of missing documentation required for claims processing, working closely with clinical and administrative teams to close documentation gaps.
• Track key RCM performance metrics (denial rates, days in A/R, clean claim rates, collection percentages) and report regularly to leadership with variance analysis and action plans.

Process Improvement & Cross Functional Collaboration

• Identify and execute process improvement opportunities across both compliance and RCM workflows, eliminating inefficiencies and reducing revenue leakage.
• Serve as the primary liaison between clinical operations, billing, coding, and administrative teams to ensure alignment on documentation requirements and billing protocols.
• Support payer audits, RAC audits, and internal investigations by preparing documentation, coordinating responses, and managing timelines.
• Stay current on federal and state regulations affecting long-term care billing, hospitalist services, Medicare/Medicaid reimbursement, and value-based care models.

Qualifications

• Experience in revenue cycle management, compliance, or coding operations within a nursing home, long-term care, or hospitalist setting.
• CPC certification (AAPC) preferred, or equivalent coding/compliance credentials (CCS, CPMA, CHC).
• Strong working knowledge of E&M coding, medical record auditing, and CMS billing regulations for skilled nursing facilities and hospitalist services.
• Demonstrated experience with denial management, claims review, appeals, and payer relations.
• Proficiency with EHR systems commonly used in long-term care and hospitalist environments, including Sigmacare, PointClickCare, Wellsky, Visual, Epic, and/or Allscripts.
• Familiarity with Medicare Part A/B billing, MDS/RUG classifications, and Medicaid reimbursement models.
• Strong analytical skills with the ability to interpret claims data, audit results, and financial reports to drive decision-making.
• Excellent communication and interpersonal skills, with the ability to collaborate effectively across clinical, administrative, and executive teams.
• Bachelor’s degree in Health Administration, Business, or a related field preferred.
• Preferred skills include experience building or optimizing RCM workflows from the ground up in a growing healthcare organization, background in provider education and one-on-one coding feedback sessions, working knowledge of value-based care arrangements and quality reporting programs (MIPS, HEDIS, Star Ratings), project management ability, familiarity with compliance program frameworks (OIG guidance, corporate integrity agreements, internal monitoring plans), and bilingualism (English/Spanish).

Impact of the Role

This role has a direct, measurable impact on the financial health and regulatory standing of Essen’s Nursing Home and Hospitalist operations. Your work strengthens documentation accuracy, reduces denials, improves compliance, and streamlines the revenue cycle, all contributing to Essen’s ability to continue delivering care to some of New York’s most underserved communities. You will work alongside clinical leaders, billing teams, and executive stakeholders, shaping provider education, informing operational strategy, and directly contributing to Essen’s growth as a premier healthcare organization.