Senior Manager, Back End Revenue Cycle

This is a fully remote position, open to applicants in Alaska, +9 more states.

📋 Description

• Develop and sustain ongoing supervision of ANSI X12 277CA claim acknowledgment transactions to verify that payers have received the claims submitted.

• Create a tracking and escalation procedure for claims that do not receive 277CA acknowledgment within specific payer-defined timeframes.

• Collaborate with the Front End Revenue Cycle Manager and Engineering to ensure accurate claim submissions and reduce rejection rates at the clearinghouse level.

• Retain a thorough understanding of clearinghouse workflows and claim status tracking functionalities.

• Take responsibility for the Athena Health AR aging report — ensuring it accurately represents payment status and is actively managed on a scheduled basis.

• Develop AR follow-up workflows categorized by payer and aging bucket, including defined SLAs and escalation processes for each tier.

• Propel systematic reduction of the over-180-day AR balance through focused payer follow-up, appeals, and collection activities.

• Collaborate with Finance and the Manager/Director of Operational Effectiveness to ensure AR balances in Athena are correctly mirrored in Zuora and NetSuite via a defined reconciliation process.

• Identify and escalate AR balances where the insurance collection route has been exhausted and the employer guarantee of payment clause might be applicable.

• Construct and oversee a structured denial work queue in Athena Health with assigned ownership, established SLAs, and a clear resubmission procedure for each denial reason code.

• Examine denial trends by payer, reason code, and service line to uncover root causes and implement preventive controls to avoid recurrence.

• Prioritize denial resolution according to dollar value and timely filing window expiration — ensuring that high-value, near-deadline denials are addressed first.

• Establish workflows for appeals related to specific payer appeal processes, including the requirements for supporting documentation and submission timelines.

• Monitor denial overturn rates by payer and reason code, utilizing outcomes data to enhance appeal strategies.

• Collaborate with the Front End Revenue Cycle Manager to tackle eligibility-driven denials at the source — denials indicating coverage terminations that should have been identified earlier.

• Oversee the collections process for both claims-billed payer groups.

• Set up payer-specific follow-up protocols including call queues, correspondence templates, and escalation timelines.

• Coordinate with Client Success on employer group collections, encompassing communication protocols and escalation to the employer guarantee of payment process when applicable.

• Track and report on cash collection rates by payer in relation to contracted PMPM rates, identifying and investigating discrepancies.

• Recruit, onboard, and develop back-end RCM personnel, including AR follow-up specialists, denial management analysts, and collectors.

• Define competency requirements, training programs, and performance expectations for all back-end roles — with a strong focus on experienced denial management and collections staff.

• Conduct regular AR review meetings with staff to ensure accounts are being managed effectively and escalations are appropriate.

• Foster a culture of accountability, data-driven decision-making, and continuous improvement within the back-end team.

⛳️ Requirements

• 7+ years of experience in revenue cycle management, emphasizing back-end functions such as AR management, denial management, and collections.

• In-depth knowledge of payer-specific denial reason codes, appeal processes, and timely filing requirements across major commercial payers.

• Proven track record in reducing AR aging and enhancing denial overturn rates within a complex payer environment.

• Experience with Athena Health or a similar practice management and claims system — particularly in AR follow-up and denial management workflows.

• Established capability to build and lead a collections and denial management team.

• Demonstrates proactive utilization of AI tools to enhance individual productivity and efficiency.

🏝️ Benefits

• Offers Equity