Manager, Revenue Cycle Operations

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

📋 Description

• Collaborate with various teams to synchronize claims processes, ensure optimal claim performance, and enhance operational efficiency with a focus on accountability, problem-solving, and excellence.

• Oversee comprehensive billing and coding operations encompassing fee-for-service, capitation, and hybrid payment models.

• Supervise daily claims workflows, denials, and claim edits to guarantee clean and compliant submissions across all states and payers.

• Verify that provider documentation complies with encounter-level billing requirements, particularly for virtual and episodic care models.

• Act as the escalation point for significant payer denials, coding inconsistencies, and claim rejections necessitating cross-department collaboration.

• Monitor essential RCM KPIs (e.g., clean claim rate, AR days, denial rate, chart lag, encounter reconciliation) and present insights to leadership.

• Collaborate with analytics to create dashboards that facilitate real-time decision-making and revenue forecasting.

• Identify critical trends and lead cross-functional initiatives aimed at enhancing performance, quality, and efficiency.

• Ensure accurate coding and encounter reconciliation processes under capitation and full-risk agreements.

• Work with medical, product, and operations teams to align payment integrity with clinical outcomes and contractual objectives.

• Directly supervise billing and coding staff; establish shift structures, review cycles, and career development plans.

• Foster accountability through performance metrics, adherence to SOPs, and real-time coaching.

⛳️ Requirements

• 8+ years of progressive experience in revenue cycle management, including at least 5 years in leadership or strategic operations roles with direct accountability for outcomes (clean claim rate, AR, denials, payer yield).

• Demonstrated success in building or revitalizing RCM operations within a multi-state or multi-payer environment.

• Strong understanding of payer policy interpretation, provider enrollment workflows, and payer portal management for both Medicaid and commercial lines of business.

• Practical experience with capitated and value-based payment models, encounter reconciliation, and HEDIS/quality measure integration.

• Advanced expertise in Athenahealth (or a similar enterprise EHR) with a proven ability to optimize claim scrub rules, taxonomy mapping, and automation logic.

• Lean Six Sigma, PMP, or process optimization experience is highly preferred.

• Familiarity with coding and documentation standards in pediatric, primary care, or behavioral health is preferred.

• Certified Professional Coder (AAPC or AHIMA) is required; additional certifications (CPPM, CPCO, or CHFP) are preferred.

• Proficient in Excel, Tableau, and claims analytics tools; capable of extracting and translating data into operational insights.

🏝️ Benefits

• Competitive medical, dental, and vision insurance

• Healthcare and Dependent Care FSA; Company-funded HSA

• 401(k) with 4% match, vested 100% from day one

• Employer-paid short and long-term disability

• Life insurance at 1x annual salary

• 20 days PTO + 10 Company Holidays & 2 Floating Holidays

• Paid new parent leave

• Additional benefits to be detailed in offer