Revenue Cycle & Claims Operations Manager

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

📋 Description

• Take ownership of comprehensive claims and revenue-cycle operations, which encompass claim readiness, submission, rejections, denials, appeals, payer follow-up, payment posting, reconciliation, aging, and collections reporting across Medicaid managed care, commercial, and various payer programs.

• Develop and enhance billing workflows that are specific to payers and programs, including claim configuration, test claims, provider and rendering setup, coding/modifier requirements, credentialing, linkage readiness, and scalable processes across internal systems, clearinghouses, and payer portals.

• Foster cross-functional execution and accountability by collaborating with Operations, Partner Success, Clinical, Product, Data, and Finance teams to address missing data, improve handoffs, eliminate recurring workflow challenges, and establish a scalable RCM function capable of supporting over $1M in monthly claims.

• Transform completed services and program requirements into precise and timely claims.

• Manage outcomes from claim readiness through to cash collection.

• Collaborate across Finance, Operations, Partner Success, clinical teams, and external payers to gather missing information and resolve outstanding issues.

• Enhance internal processes and systems that support clean claims and predictable collections.

⛳️ Requirements

• Minimum of 7 years of experience in medical billing, claims operations, or revenue-cycle management.

• At least 3 years of experience leading or managing a significant portion of a revenue-cycle function.

• Extensive hands-on experience with claim submission, rejections, denials, appeals, payer follow-up, payment posting, and accounts receivable management.

• Familiarity with Medicaid managed-care plans and complex payer requirements.

• Proven ability to configure and implement new payer or program billing workflows.

• Knowledge of billing and rendering-provider structures, NPIs, modifiers, diagnosis codes, procedure codes, authorizations, and timely-filing requirements.

• Capability to work effectively without a fully integrated EHR or mature claims infrastructure.

• Strong analytical, organizational, and project management skills.

• Ability to collaborate cross-functionally and hold both internal and external stakeholders accountable.

• Comfortable operating in both a strategic and tactical manner within a fast-growing environment.

• Strong ownership mindset with a focus on measurable collection outcomes.

• Preferred: Experience in occupational therapy, home health, behavioral health, HCBS, value-based care, or other nontraditional provider models.

• Preferred: Experience with provider credentialing, payer enrollment, CAQH, roster management, and provider linkage.

• Preferred: Experience in bringing revenue-cycle operations in-house or transitioning between billing vendors.

• Preferred: Experience implementing or optimizing claims management, practice management, clearinghouse, or RCM technology.

• Preferred: Familiarity with Salesforce, Waystar, Availity, PaySpan, or similar systems.

• Preferred: Experience in a healthcare startup or rapidly scaling organization.

• CPC, CPB, CRCR, or a similar certification is a plus, but not mandatory.

🏝️ Benefits

• Generous company funding for our health, vision, and dental plans.

• HSA plan with company contributions.

• FSA plan available.

• Short and long-term disability coverage.

• Life and personal accident insurance.

• Hospital insurance coverage.

• 401k plan available immediately upon hire.

• Generous candidate referral program.

• Annual wellness stipend.

• Unlimited PTO plus 10 paid holidays.

• $1000 stipend to cover work-from-home costs.

• Regular team off-sites and gatherings across the country.

• Collaborative team environment.

• Monthly town halls.

• High trust environment.

• A laptop and company swag provided upon hire.

• Company equity offered.