Revenue Cycle Manager

Job Purpose

The Revenue Cycle Manager is responsible for overseeing revenue integrity initiatives, clinical documentation improvement, coding quality, provider education, and revenue cycle optimization activities under the direction of the Director of Revenue Cycle Management. This position partners clinical leadership, operational departments, and revenue cycle teams to improve charge capture, reduce denials, ensure documentation compliance, optimize reimbursement, and support organizational financial performance.

The Revenue Cycle Manager serves as a departmental subject matter expert in ophthalmology clinical workflows, coding, documentation requirements, payer regulations, and revenue cycle best practices. This role supports staff education, conducts revenue cycle analysis, identifies documentation and coding opportunities, and assists leadership in implementing process improvements designed to enhance revenue integrity, compliance, and financial performance.

The Revenue Cycle Manager provides direct leadership and oversight to Revenue Cycle Supervisors and designated revenue cycle leaders while coordinating revenue integrity, documentation improvement, coding quality, education, and revenue cycle optimization activities under the direction of the Director of Revenue Cycle Management.

Duties and Responsibilities

The Revenue Cycle Manager works with clinics and other internal and external contacts in order to maintain:

• Conduct ongoing reviews of clinical documentation, coding, and charge capture processes to support revenue integrity and coding integrity.

• Identify documentation, coding, and billing opportunities through routine audits and analysis of provider and departmental performance.
• Review revenue cycle trends and recommend process improvements to the Director of Revenue Cycle Management.
• Assist with the development, implementation, and monitoring of revenue integrity initiatives.
• Provide direct oversight, guidance, and support to Revenue Cycle Supervisors and designated revenue cycle team leaders.
• Establish departmental priorities, monitor performance expectations, and ensure accountability for assigned revenue cycle functions.
• Mentor, coach, and develop revenue cycle staff to promote professional growth and operational excellence.
• Coordinate and collaborate with Revenue Cycle Supervisors, coding staff, billing staff, case management team, and other revenue cycle personnel to ensure alignment with organizational goals.
• Serve as the escalation point for complex coding, documentation, reimbursement, payer, and revenue integrity issues requiring management review.
• Support implementation of strategic initiatives established by the Director of Revenue Cycle Management while ensuring effective execution throughout the department.

Skills and Abilities

• Demonstrated experience in revenue integrity, clinical documentation improvement, coding compliance, charge capture, denial prevention, reimbursement optimization, and revenue cycle operations.
• Strong knowledge of physician and ambulatory surgery center (ASC) billing and reimbursement processes.
• Experience with commercial, Medicare, Medicaid, Medicare Advantage, and managed care payer requirements, policies, and reimbursement methodologies.
• Demonstrated success identifying and implementing revenue cycle process improvements that enhance operational performance, compliance, and financial results.
• Experience auditing clinical documentation, coding, claims, and reimbursement activity to identify opportunities and mitigate compliance risk.
• Experience utilizing revenue cycle reporting, data analytics, and performance metrics to support operational decision-making and process improvement.
• Experience with eClinicalWorks (eCW) Practice Management, SIS, and other healthcare revenue cycle systems preferred.
• Advanced proficiency in Microsoft Excel, report development, data analysis, and coding and claims auditing.
• Experience utilizing reporting, analytics, automation, and AI-enabled tools to improve efficiency and support revenue cycle performance preferred.

Education

• Associate's Degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred but not required.
• Equivalent combination of ophthalmology revenue cycle experience, leadership experience, and professional certifications may be substituted for formal education.
• Ophthalmology-specific certifications, revenue cycle certifications, revenue integrity certifications, clinical documentation improvement certifications, and healthcare compliance certifications are strongly preferred.

Experience

• Minimum five (5) years of progressive revenue cycle experience in ophthalmology, multispecialty, ambulatory healthcare, or physician practice settings. Ophthalmology leadership experience combined with significant clinical documentation improvement, coding, or revenue integrity experience will be considered.
• Minimum three (3) years of leadership experience managing, supervising, or mentoring revenue cycle staff.
• Demonstrated experience in revenue integrity, clinical documentation improvement, coding compliance, charge capture, denial prevention, reimbursement optimization, and revenue cycle operations.
• Experience with commercial, Medicare, Medicaid, Medicare Advantage, and managed care payer requirements, policies, and reimbursement methodologies.
• Experience auditing clinical documentation, coding, claims, and reimbursement activity to identify opportunities and mitigate compliance risk.
• Experience with eClinicalWorks (eCW) Practice Management, SIS, and other healthcare revenue cycle systems preferred.
• Advanced proficiency in Microsoft Excel, report development, data analysis, and coding and claims auditing.
• Experience utilizing reporting, analytics, automation, and AI-enabled tools to improve operational efficiency and support revenue cycle performance preferred.

Work conditions

The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Work is performed in a standard office environment.

Physical requirements

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• OCSR (Ophthalmic Coding Specialist-Retina)
• OCS (Ophthalmic Coding Specialist)
• CRCR (Certified Revenue Cycle Representative)
• CRIP (Certified Revenue Integrity Professional)
• CDEO (Certified Documentation Expert Outpatient)
• Other equivalent ophthalmology, revenue cycle, revenue integrity, compliance, or documentation improvement certifications.

Salary range approximately $65,000-$112,000 based on experience