Manager, Revenue Cycle Operations

This is a fully remote position, open to applicants in Texas.

📋 Description

• Oversee daily billing and coding functions across various markets, payers, service lines, and payment models, with direct supervision of Billing and Coding Supervisors.

• Track coding queues, billing worklists, claim submissions, denials, rejections, and operational backlogs; ensure staffing and capacity planning align with service level requirements.

• Utilize in-depth knowledge of CPT, ICD-10-CM, HCPCS, payer edits, and coding compliance to analyze complex operational challenges.

• Act as the escalation point for intricate billing, coding, workflow, staffing, and payer-related concerns, coordinating resolutions across functions.

• Collaborate with Revenue Integrity and Compliance on advanced audits, policy interpretation, and integrity investigations.

• Ensure operational controls are in place and maintained as new workflows, payer requirements, or audit findings are introduced.

• Guide, mentor, and grow Billing and Coding Supervisors and their respective teams.

• Enhance supervisory leadership skills through coaching in personnel management, prioritization, delegation, and problem-solving.

• Establish management routines, translate departmental goals into KPIs and execution strategies, and pinpoint performance gaps.

• Assist in workforce planning, recruitment, onboarding, and training as operations expand.

• Own and track Revenue Cycle KPIs, such as coding productivity and quality, turnaround time, backlog, denials, and worklist performance.

• Leverage data and analytics partnerships to recognize risks, capacity limitations, and opportunities for improvement.

• Report on performance metrics, risks, and action plans to Revenue Cycle leadership.

• Maintain and enhance Revenue Cycle workflows, SOPs, and controls; lead efforts for efficiency and scalability improvements.

• Prepare for the introduction of new markets, payers, and programs while escalating systemic issues that require broader intervention.

• Collaborate with Revenue Integrity, Analytics, Compliance, Credentialing, Clinical Operations, Payer/Partner teams, and Product/Technology to address issues, implement changes, and achieve results.

⛳️ Requirements

• A minimum of 7 years of progressive experience in Revenue Cycle management.

• Significant experience in coding and billing operations is essential.

• At least 3 years of direct leadership experience, including managing supervisors or frontline leaders.

• Certification as a Professional Coder (AAPC or AHIMA) is required.

• CPPM, CPCO, or CHFP certifications are preferred.

• Proven ability to manage coding operations, focusing on productivity, quality, turnaround time, backlog, and denials.

• Strong understanding of CPT, ICD-10-CM, HCPCS, documentation requirements, payer edits, and coding compliance principles.

• Capability to assess operational issues, interpret QA findings, and identify when escalations to Revenue Integrity or Compliance are necessary.

• Demonstrated ability to coach, hold accountable, and develop frontline leaders and high performers.

• Proven experience in leading through others and enhancing team capabilities across multiple payers, markets, and service lines.

• Excellent communication and relationship management skills across clinical, operational, technical, and compliance teams.

• Familiarity with Athenahealth or a similar EHR/practice management platform is highly desirable.

• Experience in pediatric, value-based, or high-growth environments is advantageous.

🏝️ Benefits

• Annual bonus incentive.

• Competitive company benefits package.

• Eligibility for employee equity purchase program (as applicable).

• Comprehensive medical, dental, and vision insurance.

• Healthcare and Dependent Care FSA.

• Company-funded HSA.

• 401(k) plan with 4% match, fully vested from day one.

• Employer-paid short and long-term disability coverage.

• Life insurance equivalent to 1x annual salary.

• 20 days of paid time off (PTO).

• 10 Company holidays.

• 2 Floating holidays.

• Paid parental leave for new parents.

• Additional benefits will be outlined in the offer.