REVENUE CYCLE MANAGER

Position Title: Revenue Cycle Manager

Department: Business Office

Supervisor’s Title: Chief Financial Officer

Position Summary

The Revenue Cycle Manager is responsible for developing, planning, organizing, and implementing strategies to optimize billing, collections, and reimbursement while ensuring compliance with all federal and state regulations. This position oversees day-to-day revenue cycle functions including registration, billing, collections, coding, prior authorization, Health Information Management (HIM), accounts receivable, and financial counseling.

The manager builds and executes proactive strategies to prevent denials before they occur, ensure accurate and timely reimbursement, and position Valor Health for scalable growth. The role drives the use of automation, innovation, and process redesign to improve efficiency and transparency while placing the patient financial experience at the forefront of all activities. The Revenue Cycle Manager serves as a subject matter expert on reimbursement, payer relations, and revenue cycle best practices, and partners across departments to align revenue cycle outcomes with the broader goals of the health system.

Principal Functions and Responsibilities

1. Develop strategic plans and programs for the Revenue Cycle team and ensure goals and objectives are properly defined and clearly established.
2. Provide or ensure the correct technical expertise related to CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases) coding, with preparation for ICD-11 adoption.
3. Oversight of the Chargemaster, including maintaining a system to track, revise, and update with the appropriate CPT and ICD-10 codes for accurate and timely charging of services.
4. Develop and utilize quality improvement tools to measure billing accuracy and efficiency. Address areas of concern identified from such efforts and report to the CFO.
5. Provide training for all Valor providers and appropriate staff on changes or updates to coding and billing practices for Critical Access Hospitals.
6. Assure compliance with HIPAA privacy and security standards, the No Surprises Act, the CMS Hospital Price Transparency Rule, Medicare Advantage authorization requirements, and other applicable federal and state billing regulations.
7. Maintain strong relationships with insurance companies; identify and resolve issues that may slow cash flow (denial trends, new insurance plans, new providers, or network changes).
8. Drive net revenue integrity by ensuring accurate charge capture, timely reimbursement, effective patient collections, and proactive bad debt reduction strategies that safeguard the financial health of the organization.
9. Review and evaluate the performance of the team on a regular basis and ensure overall performance remains within pre-established goals and objectives.
10. Serve as the organizational subject matter expert on revenue cycle operations, payer relations, and reimbursement policy, advising leadership on regulatory shifts and payer trends.
11. Lead proactive denial prevention strategies and ensure claims are submitted accurately and timely with first-pass acceptance goals in mind.
12. Partner cross-functionally with Finance, Operations, IT, and clinical leadership to ensure revenue cycle processes are aligned with broader system strategy and patient care priorities.
13. Collaborate with IT and Data teams to implement automation, identify process bottlenecks, and uncover trends in revenue behavior that inform forecasting and strategy.
14. Guide revenue cycle staff through change initiatives, providing mentorship, structure, and clear communication during transitions.
15. Ensure audits are completed in all areas of the Revenue Cycle (registration accuracy, billing, coding, regulatory compliance, payer audits, etc.) and appropriate follow-up and education take place.
16. Regularly report performance to the CFO and other leadership, using dashboards that include but are not limited to:
    1. Days in Accounts Receivable (AR) by payer class
    2. Clean claim rate and first-pass acceptance rate
    3. Denial and avoidable write-off rates
    4. Discharged Not Final Billed (DNFB) days
    5. Patient pay collections and financial clearance rates
    6. Patient financial experience scores tied to billing and collections
17. Actively research revenue cycle best practices, benchmark performance, and implement process improvements that align Valor Health with leading industry standards.
18. Ensure patient-centered financial practices are embedded into the revenue cycle, including:
    1. Compliance with price transparency rules and accurate advance cost estimates
    2. Patient-friendly billing statements, digital payment options, and financial counseling services
    3. Integration of charity care and financial assistance programs into billing workflows
    4. Monitoring and improving patient satisfaction with billing and collections
19. Other duties as assigned.