Revenue Cycle Manager

Strategic Planning & Optimization:

• Develop, implement, and refine revenue cycle policies and procedures to improve operational efficiency and maximize revenue.

• Identify areas for process improvement and lead initiatives to enhance revenue integrity and reduce costs.

• Collaborate with various departments (e.g., clinical, finance, IT) to streamline workflows and ensure seamless revenue cycle operations.

• Stay updated on industry trends, payer policies, and healthcare regulations to adapt strategies accordingly.

Team Leadership & Management:

• Lead, mentor, and develop a high-performing team of billing, coding, and collections specialists.

• Set strategic goals for the team and ensure alignment with organizational objectives.

• Conduct regular performance reviews, provide constructive feedback, and facilitate professional growth for team members.

• Oversee daily operations, manage workloads, and ensure adherence to established procedures.

Claims & Denial Management:

• Oversee the accurate and timely submission of claims to insurance companies and other payers.

• Manage the denial and rejection management process, identifying root causes, implementing corrective actions, and ensuring timely resubmissions.

• Negotiate with insurance providers and other payers to resolve complex billing issues and improve reimbursement rates.

Financial Analysis & Reporting:

• Monitor key performance indicators (KPIs) related to revenue cycle performance (e.g., days in A/R, clean claim rate, denial rate, collection rates).

• Analyze financial reports and data to identify trends, inefficiencies, and opportunities for improvement.

• Present actionable insights and recommendations to leadership regarding revenue cycle performance and financial health.

• Oversee monthly close processes, including reporting and account balancing.

Compliance & Regulatory Adherence:

• Ensure all billing and collection processes comply with federal, state, and local healthcare regulations, including HIPAA, Medicare, Medicaid, and other payer requirements.

• Conduct internal audits to ensure accuracy and compliance.

• Develop and deliver training programs for staff on revenue cycle best practices, coding guidelines, and regulatory changes.

Patient & Payer Relations:

• Oversee the resolution of patient billing inquiries and complaints, ensuring a positive patient financial experience.

• Cultivate strong relationships with payers to facilitate efficient claims processing and dispute resolution.

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field.

• Minimum of 5-7 years of progressive experience in healthcare revenue cycle management, with at least 2-3 years in a leadership or supervisory role.
• Proven track record of optimizing revenue cycle processes and improving financial outcomes.

• In-depth knowledge of healthcare billing, coding (ICD-10, CPT, HCPCS), and reimbursement methodologies.
• Proficiency in revenue cycle management (RCM) software, electronic health record (EHR) systems, and practice management systems.
• Strong analytical skills, including data analysis, financial modeling, and reporting (proficiency in Excel required).
• Familiarity with medical necessity guidelines and compliance standards.

• Excellent leadership, team management, and mentoring abilities.
• Exceptional communication (written and verbal), interpersonal, and negotiation skills.
• Strong problem-solving and critical thinking skills with a proactive approach.
• Detail-oriented with strong organizational and time-management abilities.
• Ability to adapt to a fast-paced, dynamic environment and manage multiple priorities effectively.
• High degree of integrity and commitment to ethical conduct.

• Master’s degree in a related field.
• Relevant certifications (e.g., Certified Revenue Cycle Representative (CRCR), Certified
• Professional Coder (CPC), Certified Professional Biller (CPB)).