Senior Manager, Revenue Cycle Management, Provider Operations

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

📋 Description

• Take ownership of the strategy and performance for Oscar Medical Group's revenue cycle operations, which encompasses professional billing, coding, claims management, denials, eligibility, documentation, and associated workflows.

• Act as the senior expert in coding and billing, covering CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, and payer requirements.

• Establish and evaluate revenue cycle KPIs and controls through data analysis and root-cause assessments to enhance clean claims, coding accuracy, reimbursement rates, denial rates, and overall financial performance.

• Spearhead coding and documentation integrity initiatives, including pre- and post-bill reviews, provider queries, addendums, signatures/co-signatures, documentation practice evaluations, and provider training.

• Drive denial prevention and resolution strategies while implementing sustainable corrective measures.

• Collaborate with clinical leadership on ICD-10/HCC documentation and coding practices.

• Assess payer-specific performance, requirements, and coding considerations to formulate strategies for reimbursement, eligibility, claim-editing, and denial management.

• Work alongside Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders on intricate revenue cycle challenges and new initiatives.

• Create scalable revenue cycle policies, workflows, governance, and vendor oversight to support a growing, multi-state provider organization.

• Provide counsel to Oscar Medical Group leadership regarding revenue cycle performance, financial prospects, operational risks, and suggested strategies.

• Ensure adherence to relevant laws and regulations.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• A minimum of 7 years of progressive experience in healthcare revenue cycle management, professional billing, coding, or related healthcare operations.

• At least 3 years of experience in leading revenue cycle programs, teams, or functions with responsibility for operational and/or financial results.

• Extensive knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements.

• Proven experience in developing and implementing revenue cycle strategies that enhance coding accuracy, claims performance, reimbursement, and overall financial results.

• Familiarity with coding and clinical documentation integrity, including provider documentation reviews, provider queries, and pre- and post-bill review processes.

• Capability to analyze complex revenue cycle data, identify trends and root causes, and convert findings into actionable strategies and recommendations.

• Experience in leading complex, cross-functional projects and collaborating with clinical, operations, finance, compliance, credentialing, and other stakeholders.

• Exceptional executive communication skills, with the ability to convey complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership.

🏝️ Benefits

• Employee benefits

• Unlimited vacation program

• Annual performance bonuses

• Medical, dental, and vision benefits

• 11 paid holidays

• Paid sick time

• Paid parental leave

• 401(k) plan participation

• Life and disability insurance

• Paid wellness time and reimbursements