Senior Manager, Revenue Cycle Management, Provider Operations

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

📋 Description

• Oversee and enhance revenue cycle operations within Oscar Medical Group.

• Take ownership of the strategy and performance related to professional billing, coding, claims management, denials, eligibility, documentation, and associated workflows.

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

• Set and track revenue cycle KPIs and controls through data analysis and root-cause evaluations.

• Spearhead strategies for coding and documentation integrity, including pre- and post-bill reviews, provider queries, addendums, signatures/co-signatures, and educational initiatives for providers.

• Drive strategies for denial prevention and resolution 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.

• Work alongside Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other key stakeholders.

• Create scalable revenue cycle policies, workflows, governance structures, and vendor oversight.

• Counsel Oscar Medical Group leadership regarding performance, financial opportunities, operational risks, and strategic initiatives.

• Ensure adherence to applicable laws and regulations.

• Execute other duties as assigned.

⛳️ Requirements

• 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 accountability for operational and/or financial results.

• Advanced understanding 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 outcomes.

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

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

• Experience in leading complex, cross-functional initiatives involving clinical, operations, finance, compliance, credentialing, and other stakeholders.

• Strong executive communication skills for articulating complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership.

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Medical Auditor (CPMA), or similar coding/revenue cycle certification (preferred).

• Experience in supervising or overseeing coding professionals and/or certified coders (preferred).

• Background in a multi-state medical group, telehealth organization, or a complex healthcare delivery setting (preferred).

• Familiarity with both provider and payer environments (preferred).

• Knowledge of risk-adjustment coding, including ICD-10/HCC documentation and coding practices (preferred).

• Experience with credentialing and payer enrollment processes (preferred).

• Experience managing external revenue cycle, coding, or billing vendors (preferred).

🏝️ Benefits

• Employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• 401(k) plan participation.

• Life insurance.

• Disability insurance.

• Paid wellness time and reimbursements.