Revenue Cycle Manager

About the role

The Revenue Cycle Manager plays a crucial role in ensuring the financial health and operational efficiency of the organization by overseeing accurate billing, reimbursement, and care coordination for infusion services. By auditing vendor performance, verifying insurance coverage, securing prior authorizations, and managing claims and denials, this role directly supports timely patient access to care and maximizes revenue capture. Their expertise in payer requirements, coding standards, and compliance regulations helps prevent costly errors, reduce delays, and maintain strong payer relationships. Through collaboration with internal teams and external partners, the Revenue Cycle Manager strengthens workflow integrity and enhances both the patient and provider experience.

Responsibilities

• Work with vendors and audit the vendor’s completion of comprehensive benefit investigations to verify patient coverage and eligibility.
• Audit to ensure compliance with payer-specific prior authorization requirements and documents to secure necessary approvals and moving patients to the next step in process.
• Review the accurate collection and reconciliation of patient and third-party funds via audit of vendor follow up.
• Help leadership train and provide education via audits for vendors to perform accurate coding of billable services in accordance with current coding standards and payer guidelines.
• Submit claims and monitor their status to ensure timely and accurate reimbursement.
• Resolve claim edits and denials efficiently.
• Aid vendors in the posting of payments from both payers and patients, ensuring accuracy and compliance with internal controls.
• Maintain a strong working knowledge of EMR systems, healthcare compliance standards, and applicable federal and state regulations.
• Establish and maintain relationships with third parties such as vendors and payers.
• Coordinate care with all parties involved.
• Work on any denials or claims requests such as appeals, resubmissions or additional documentation requests.
• Work with leadership to create and keep SOPs up to date and available for vendors to utilize.
• Provide backup to front desk/administration assistance, if the candidate is local.

Who You’ll Be Working With

The Revenue Cycle Manager is responsible for working directly with patients, payers, prescribers, and other clinical and administrative staff.

Skills and Experience

• A college degree and/or at least two years’ medical coding, billing and reconciliation experience in the healthcare industry is required; Pharmacy and Infusion preferred.
• Related experience in collections, finance, patient care and communications, or similar qualifications are highly desirable.
• Experience in front end intake functions and processes is beneficial.
• Strong project management and cross-functional team collaboration skills with a demonstrated ability to plan and drive results and achieve deadlines (especially pertaining to diligently working within Timely Filing Constraints) is key.
• Knowledge of EMR systems, healthcare compliance and related legislation is a must.

Competencies

• Key advocate for patient education on benefits, approvals and any cost shares expected.
• Outstanding verbal and written communication skills will be important as they will be a key contact point for the company and vendors.
• High level of technical savvy across multiple platforms such as Windows, Microsoft Office Suite, and healthcare-related software such as payor portals, EMR systems, clearinghouse, etc.
• Ability to maintain and adhere to a strict level of confidentiality, demonstrate outstanding judgement and be able to manage multiple tasks or projects simultaneously.

Work Environment

The Revenue Cycle Manager thrives in a fast-paced work environment. They must be able to sit for prolonged periods of time at a desk and perform work on a computer in an office environment. Light to moderate lifting may be required at times. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential job functions. The position is remote but may require occasional visits to our Headquarters in Kalamazoo, MI, for meetings or training.

Salary

$75,000-$85,000