Revenue Cycle Manager

Job Summary

Under the general direction of the Chief Financial Officer, the Revenue Cycle Manager provides leadership, oversight, and strategic direction for all aspects of the revenue cycle to include but not limited to reimbursement optimization, denial management, and accounts receivable performance. Develop and maintain efficient workflows, monitoring key revenue cycle metrics, planning, developing, and implementing strategies to maximize revenue and, optimizing revenue cycle processes and systems, managing third-party payer relationships, overseeing Medicare cost reports and claims, and pursuing denied claims and delinquent accounts. The Revenue Cycle Manager will oversee managed care contracting, regulatory reporting, graduate medical education (GME) reimbursement, and the effective management of fiscal resources in accordance with organizational policies and procedures.

Primary Responsibilities

• Coordinates the day-to-day operations of the Revenue Cycle Department while driving process improvement initiatives that support financial performance, regulatory compliance, and exceptional customer service
• Provide strategic and operational leadership for claims management, reimbursement, denial management, and accounts receivable
• Monitor and improve revenue cycle performance through analysis of key performance indicators (KPIs), reimbursement trends, cash collections, and accounts receivable metrics.
• Ensure accurate and timely billing and reimbursement for Medicare, Medicaid, Commercial Insurance, Managed Care, and Private Pay accounts.
• Analyze revenue cycle data to identify trends, root causes, risks and opportunities.
• Identify, investigate, and resolve billing discrepancies, denials, underpayments, and reimbursement issues to optimize cash flow and reduce A/R days.
• Develop, implement, and maintain department policies, procedures, workflows, and process improvement initiatives to enhance operational efficiency and compliance.
• Collaborate with clinical, operational, business office and financial leadership to improve revenue integrity, documentation accuracy, and reimbursement outcomes.
• Ensure compliance with HIPAA, CMS, payer regulations, coding requirements, and organizational policies and procedures.
• Assist with audits, financial reviews, budget management, and regulatory reporting as required.

Education and Experience:

• Required: Bachelors degree in Finance or related field, will consider equivalent combination of education and experience
• Required: 3 Years Revenue Cycle Management and Healthcare Reimbursement Experience
• Required: Working knowledge of all billing, payments, and credit and collection functions
• Required: Working knowledge of regulations governing healthcare revenue cycle, including the Charge master (aka Fee Book) and Coding (CPT/HCPCS).
• Preferred: High level knowledge of healthcare patient accounting applications, MS office suite and ability to comfortably learn new computer programs
• Required: Meet all Employee Health Requirement

License/Certification(s)

Preferred: Certified Professional Coder (CPC)