Manager, Revenue Cycle Operations in United States at Jobgether
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Job Description
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Manager, Revenue Cycle Operations in the United States.
This role sits at the core of a mission-driven healthcare organization focused on improving access and quality of pediatric care. You will lead end-to-end revenue cycle operations across multiple payment models, ensuring accuracy, efficiency, and compliance in billing and coding processes. The position plays a critical role in optimizing clean claim performance, reducing denials, and improving overall financial health. You will collaborate closely with clinical, product, and operations teams to align documentation, coding, and reimbursement workflows. A strong emphasis is placed on leveraging data, automation, and process improvement to enhance performance at scale. This is a high-impact leadership role in a fast-paced, multi-state, multi-payer environment with significant opportunities to shape operational strategy and outcomes.
In this role, you will oversee revenue cycle execution and drive operational excellence across billing, coding, and claims workflows. You will be responsible for ensuring accuracy, compliance, and performance across all reimbursement models while partnering cross-functionally to support growth and scalability.
- Lead end-to-end billing and coding operations across fee-for-service, capitation, and hybrid payment models, ensuring clean and compliant claims submission.
- Monitor daily claims workflows, denials, and edits while serving as escalation point for complex payer and coding issues.
- Track and analyze key RCM KPIs such as AR days, clean claim rate, denial rate, and encounter reconciliation, providing insights to leadership.
- Support capitation and value-based care operations, including encounter reconciliation, risk adjustment, and quality measure capture (e.g., HEDIS).
- Partner with Clinical, Product, Credentialing, and Compliance teams to ensure readiness across markets and payer systems.
- Lead and develop billing and coding teams, driving accountability, performance management, and continuous improvement.
- Own SOPs, workflows, and process optimization initiatives to improve scalability, automation, and operational efficiency.
- Collaborate with Product and IT teams to enhance system performance, automation tools, and claims infrastructure.
- Ensure audit readiness and compliance with CMS, OIG, and payer requirements through structured governance and documentation.
This role requires deep expertise in revenue cycle management, strong analytical capabilities, and proven leadership in complex healthcare environments. You will bring both operational rigor and strategic thinking to optimize performance and scale systems effectively.
- 8+ years of progressive revenue cycle experience, including at least 5 years in leadership or strategic RCM operations roles.
- Proven experience managing multi-state or multi-payer billing, coding, and claims operations.
- Strong knowledge of payer policies, denial management, provider enrollment, and claims adjudication workflows.
- Experience with capitation, value-based care models, encounter reconciliation, and quality reporting (e.g., HEDIS).
- Hands-on expertise with enterprise EHR systems (Athenahealth or similar), including claims optimization and workflow automation.
- Strong analytical skills with proficiency in Excel, Tableau, and claims data interpretation tools.
- Certified Professional Coder (AAPC or AHIMA required), with additional certifications (CPPM, CPCO, CHFP) preferred.
- Experience in pediatric, primary care, or behavioral health coding strongly preferred.
- Lean Six Sigma or process improvement certification (preferred).
- Strong leadership, communication, and cross-functional collaboration skills with a focus on accountability and results.
- Competitive base salary range of $100,000 – $130,000
- Annual performance-based bonus incentive
- Employee equity purchase program eligibility
- Comprehensive medical, dental, and vision insurance
- Healthcare and dependent care Flexible Spending Accounts (FSA)
- Company-funded Health Savings Account (HSA)
- 401(k) plan with 4% employer match, fully vested from day one
- Employer-paid short-term and long-term disability coverage
- Life insurance coverage at 1x annual salary
- 20 days PTO, 10 company holidays, and 2 floating holidays
- Paid parental leave
- Additional benefits shared upon offer.