United States onlyTeam Values1. Empathy (First) - Every patient’s journey is unique, and we approach each with compassion and understanding, always treating patients with dignity.2. Empowerment (Through Partnership) - Patients are partners in their health journey. We strive to educate, motivate, and support them at every step.3. Respect for Diversity - We embrace and honor the unique backgrounds, cultures, and identities of every individual, fostering an environment of inclusion and understanding.4. Innovation (for Change) - We’re committed to challenging the status quo in healthcare, advancing technology and protocols to create sustainable health outcomes.5. Service - Heart of Service - With humility and purpose, we dedicate ourselves to serving others, putting compassion and commitment at the heart of everything we do.
Key Roles & Responsibilities:
- We are seeking a Revenue Cycle Manager who will lead and scale our insurance revenue operations, overseeing coders, payment posters, and denial managers. The ideal candidate brings strong analytical, operational, and technical expertise — with proven experience managing multi-entity RCM infrastructures and automating claim submission and patient billing processes.
- You will be responsible for managing and optimizing our processes for full revenue cycle — from eligibility and coding to claim submission and denial analysis.
- Lead and mentor a cross-functional team of eligibility administrators, medical coders, payment posters, and denial managers (offshore and outsourced)
- Set and monitor team KPIs, workloads, and performance dashboards
- Develop structured daily/weekly workflows and escalation protocols
- Set up and manage multi-TIN (Tax Identification Number) billing infrastructure, including payer portal access across multiple entities
- Establish and maintain SFT/SFTP systems for secure charge capture and electronic remittance processing (837/835 files)
- Build and maintain custom dashboards for denial analysis, reimbursement trends, and operational performance metrics
- Analyze claims and denial data to identify coding and billing improvement opportunities
- Create worklists and data-driven assignments for coders, posters, and denial specialists
- Develop policies and tools to reduce days in A/R, increase first-pass resolution rates, and ensure payer compliance
- Collaborate with Clinical, Product/Engineering, and Operations teams to align billing strategy with service delivery
- Support payer contracting, MIPS reporting, and special billing initiatives such as Remote Patient Monitoring (RPM)
- Maintain up-to-date knowledge of Medicare and commercial payer regulations, CPT/ICD coding updates, and reimbursement policy changes
Qualifications:
- Bachelor’s degree in Business, Finance, Accounting, Healthcare Administration, or related field
- 5+ years of experience in healthcare revenue cycle management, including claims processing, coding, and payment posting
- Proven experience leading teams and managing RCM systems in a multi-entity environment
- Strong technical understanding of SFTP, 837/835 EDI, and charge capture systems ( ability to set those up using Agentic tools is huge plus).
- Expertise in denial management, coding rules, and claims workflow optimization
- Proficient in analyzing large datasets and creating dashboards (BigQ, Looker)
- Deep knowledge of CPT, HCPCS, ICD-10, and payer billing requirements
- Familiarity with Medicare and commercial insurance reimbursement practices
- Exceptional organizational, analytical, and communication skills
- Familiarity with Apero Health billing platform is plus.
- Bonus Qualifications:1+ years of experience in Merit-Based Incentive Payment System (MIPS) reporting.
