Revenue Cycle Manager

Key Responsibilities

• Insurance Verification & Prior Authorization
• Prepare, submit, and track prior authorization requests with payers, ensuring timely approvals before treatment begins
• Follow up on pending and denied prior authorizations, escalating to payers as needed
• Maintain an organized tracking system for authorization statuses, expiration dates, and renewal deadlines
• Collaborate with clinical staff to gather required supporting documentation (clinical notes, treatment plans) for authorization submissions
• Billing & Claims Management
• Accurately prepare, review, and verify CMS-1500 claim forms for submission
• Automate billing processes and coding in conjunction with our technology team
• Setup and operate third-party tools to facilitate billing, claims submission and analytics
• Revenue Cycle Oversight
• Manage all aspects of the revenue cycle, including charge capture, claims submission, payment posting, denial management, and patient collections
• Monitor KPIs such as days in A/R, denial rates, and collections, providing regular reports to leadership
• Develop and implement processes to optimize cash flow and minimize errors
• Reconcile differences with Finance & Accounting team
• Track, categorize, and analyze claim denials to identify root causes and trends
• Manage the denial appeals process, including preparing and submitting appeal letters with supporting documentation within payer-required timelines
• Implement corrective actions to reduce denial rates (e.g., improving front-end verification, coding accuracy, or authorization compliance)

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Accounting, or related field
• 3–5 years of experience in medical billing and revenue cycle management, preferably in an outpatient or small clinic setting
• Strong knowledge of medical billing, CPT coding, insurance verification, and payer requirements
• Hands-on experience preparing and verifying CMS-1500 claim forms
• Excellent organizational skills, attention to detail, and ability to manage multiple priorities
• Strong communication and problem-solving skills, with experience coordinating with providers and external vendors
• Demonstrated experience managing prior authorization workflows, including submission, follow-up, and appeals
• Familiarity with payer-specific authorization requirements for behavioral health services

Preferred Qualifications

• Experience in behavioral health billing specifically TMS, Spravato and IOP
• Experience with facility billing (UB-04, CMS-1450)
• Experience with eligibility verification tools or clearinghouses (e.g., Availity, Waystar)
• Knowledge of Medicare/Medicaid authorization requirements for behavioral health services