Revenue Cycle Manager - DME

About the role

We are looking for an experienced, analytical, and hands-on RCM Manager to lead the revenue cycle function for XRHealth America’s growing DME business. XRHealth has a newly established revenue cycle team supporting the complete reimbursement process—from eligibility verification and prior authorization through claims submission, payment posting, denials, accounts receivable, and collections. The RCM Manager will ensure the team’s work is completed accurately, efficiently, systematically, and in compliance with payer and regulatory requirements. This person will establish clear workflows, monitor quality and productivity, train and support team members, and create accountability for results. As the business grows, the RCM Manager will also identify and implement opportunities for automation, AI, and system optimization. We are looking for a builder and hands-on leader who is comfortable working in the details while developing a scalable revenue cycle operation.

Responsibilities

• Lead the day-to-day work of the DME revenue cycle team.
• Establish clear workflows, responsibilities, priorities, productivity expectations, and quality standards.
• Monitor team performance and ensure work is completed accurately and on time.
• Train, coach, and support team members while addressing performance and knowledge gaps.
• Develop and maintain Standard Operating Procedures and quality-control processes.
• Support future hiring and team development as the business grows.
• Oversee eligibility verification, intake review, prior authorization, documentation validation, claims submission, payment posting, denials, appeals, accounts receivable, and collections.
• Ensure accurate and timely claim submission to Medicare, Medicaid, Medicare Advantage, commercial insurers, and other payers.
• Confirm that claims are supported by required documentation, including Standard Written Orders, medical records, proof of delivery, prior authorizations, and continued-use documentation.
• Oversee DME rental billing, including recurring claims, capped-rental requirements, modifiers, and continued medical-necessity requirements.
• Ensure proper use of HCPCS codes, ICD-10 codes, modifiers, fee schedules, and payer-specific billing rules.
• Maintain current knowledge of DME MAC policies, LCDs, related policy articles, and payer requirements.
• Coordinate with Operations, Logistics, Customer Success, Finance, and Compliance to resolve billing and documentation issues.
• Lead denial prevention, root-cause analysis, appeals, and payer escalations.
• Monitor accounts receivable aging and ensure timely follow-up on unpaid and underpaid claims.
• Identify trends involving denials, payment delays, authorization failures, and avoidable write-offs.
• Oversee responses to medical-record requests, payer audits, recoupments, and overpayment notices.
• Implement corrective actions that improve collections and prevent recurring issues.
• Evaluate existing processes and eliminate unnecessary manual work and inconsistent practices.
• Identify opportunities to use automation and AI to improve accuracy, productivity, claim follow-up, and reporting.
• Optimize workflows within NikoHealth and related clearinghouse, payer, financial, and reporting systems.
• Partner with Operations and Technology to improve system integrations and data integrity.
• Develop dashboards and report regularly on clean-claim rate, denial rate, days in accounts receivable, aging, collections, turnaround times, write-offs, and team productivity.
• Use revenue cycle data to identify risks and recommend operational improvements.
• Ensure compliance with Medicare, Medicaid, commercial payer, HIPAA, DMEPOS accreditation, and applicable federal and state requirements.
• Maintain controls related to billing accuracy, medical necessity, documentation, timely filing, overpayments, and claim adjustments.
• Partner with Compliance on internal