Senior Manager, RCM Optimization – Strategy

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

📋 Description

• Assess comprehensive RCM workflows from pre-billing to denial resolution and patient collections.

• Remove manual processes, eliminate operational bottlenecks, and tackle revenue leakage.

• Collaborate with the Senior Director of RCM to design, test, and implement efficient workflows.

• Manage billing system setup and configuration across Apero, Sigma, and Mahler, including payor billing logic, fee schedules, and contract terms.

• Develop, sustain, and enhance RCM KPI dashboards.

• Review billing engine rules, logic, and fee schedules to ensure compliance with payor guidelines and coding updates.

• Conduct root-cause analyses on claim denials and underpayments.

• Act as the internal checkpoint for claims escalations prior to issues being forwarded to payors.

• Collaborate with Technology teams on automating claim submissions, denials management, and revenue capture.

• Work with Payor Operations on systemic payor challenges.

• Oversee internal and clearinghouse configuration rules to resolve pre-claim edits and front-end rejections.

• Coordinate with Licensing & Credentialing, Authorization & Eligibility, Patient Access, and Clinical Operations to minimize claim errors and intake-related denials.

• Lead change management initiatives for new billing tools, software integrations, and workflow modifications.

• Provide executive-level insights on RCM, including progress updates and financial performance reporting.

⛳️ Requirements

• Over 6 years of progressive experience in healthcare revenue cycle management, with a minimum of 3 years in an analytical, optimization, or process improvement role.

• Bachelor’s degree in Healthcare Administration, Finance, Business Analytics, or a related field, or 10+ years of experience in healthcare RCM.

• Documented success in utilizing complex data sets to optimize RCM operations, lower claim denials, and recover lost revenue.

• Strong background in project management, with a proven history of leading cross-functional tech or process improvement initiatives.

• Exceptional analytical and problem-solving capabilities, with a keen attention to detail.

• Excellent written and verbal communication skills, with the ability to convey complex revenue cycle data into clear, actionable insights for diverse teams.

• Highly collaborative approach with a demonstrated ability to build effective relationships across clinical, operational, and technical leadership.

• Familiarity with insurance payor policies, billing guidelines, and claims submission requirements.

• Knowledge of CPT and ICD-10 codes and their impact on billing and reimbursement.

• Practical experience with payor contract analysis, fee schedule audits, and underpayment identification and recovery.

• Experience in configuring billing platforms; familiarity with Apero, Sigma, Mahler, or similar RCM software is preferred.

• Background in behavioral health or telehealth billing is preferred.

• Previous experience in a dynamic, high-growth, or startup healthcare environment is preferred.

• Hands-on experience in building custom clearinghouse rules and RPA/AI solutions is preferred.

• Advanced technical skills in SQL, BI reporting platforms, EHR/PM systems, and clearinghouse rule builders are preferred.

🏝️ Benefits

• 401k with matching contributions.

• Flexible paid time off.

• Paid holidays.

• Paid service days.

• 4-week paid sabbatical.

• 12-week paid parental leave.

• Health benefits commencing on your first day.

• Fully virtual work-from-home arrangement.

• Occasional in-person retreats.