Revenue Cycle Claims Manager

About the Role

The Claims Manager at St. Charles Health System leads the daily operations of the claims function, including billing and insurance follow-up, to optimize reimbursement and support organizational revenue cycle goals. This role oversees claims operations, drives denial prevention and resolution efforts, analyzes claims performance, and implements process improvements that enhance efficiency, compliance, and financial outcomes. The Claims Manager collaborates with clinical, operational, and revenue cycle leaders to resolve complex claims issues, ensure adherence to billing regulations and payer requirements, and promote best practices across the organization.

This position provides leadership, coaching, and development for claims supervisors and caregivers while fostering a culture of accountability, continuous improvement, and exceptional service. This position directly supervises other caregivers.

Responsibilities

• Manages the overall operations of claims teams.
• Develops and maintains department policies and procedures.
• Manages the creation and maintenance of training manuals, guides, and standard work.
• Attends and/or leads applicable meetings including huddles, staff meetings, payer meetings, clinical and support department meetings, and educational opportunities as appropriate.
• Maintains strong working knowledge of billing regulations, coding guidelines, reimbursement methodologies, and industry best practices.
• Identifies denial trends in coordination with claim teams and other leaders through the completion of audits, claim reviews, data analysis, research, and education.
• Monitors revenue cycle metrics and implements solutions to meet metrics including education, IT optimization, and collaborations with departments, payers, and vendors. Solutions may include writing decision papers, SBAR’s, or presenting content to applicable stakeholders.
• Acts as the point person for claim-level escalations. Solutions to escalations may include writing decision papers, SBAR’s, or presenting content to applicable stakeholders.
• Supports SCHS Single Billing Office (SBO) senior director as needed.
• Supports Senior Director in budget development, regular monitoring, accountability, and meeting all operational targets for all areas within span of control.
• Manages human resource tasks including interviewing, hiring, timekeeping, coaching, mentoring, and performance management.
• Hires, directs, coaches, and monitors the performance of all direct reports to develop and maintain a high-performance team that meets organizational and department goals.
• Monitors and ensures all direct reports are current with compliance and safety requirements.
• Implements and manages all organizational safety directives and goals.
• Provides and oversees team’s delivery of customer service in a manner that promotes goodwill, is timely, efficient, and accurate.
• Collaborates with teams to review processes and identify/implement opportunities for improvements, applying Lean principles, concepts, and tools.
• Supports the vision, mission, and values of the organization in all respects.
• Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Delivers customer service in a manner that promotes goodwill and teamwork; timely, efficient, and accurate.
• Collaborates with teams to review processes and identify/implement opportunities for improvements, applying Value Improvement Practice concepts and tools.
• Provides and maintains a safe environment for caregivers, patients, and guests.
• Conducts all activities with the highest standards of professionalism and confidentiality.
• Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• May perform additional duties of similar complexity within the organization, as required or assigned.

Requirements

• Bachelor's degree in a related field. A combination of education and relevant prior experience may be substituted in lieu of a degree.
• Five years of applicable revenue cycle and/or patient financial services experience. Two years of experience in a finance field may substitute for two years’ experience.
• One year of leadership experience.

Preferred Qualifications

• Applicable revenue cycle certification including coding, compliance, and billing.
• Epic and vendor management experience.