Revenue Cycle Insurance Manager at Medical Data Systems – Sebring, Florida

Position Summary
The Revenue Cycle Insurance Manager is a senior people leader responsible for driving hospital insurance collections performance through strong leadership, accountability, and payer strategy. This role owns the execution and outcomes of hospital insurance A/R and denials management, leading teams that resolve complex, high-dollar claims while ensuring compliance, consistency, and sustained cash flow. The ideal candidate is a decisive, visible leader who develops talent, enforces standards, and partners across departments to achieve measurable financial results.
Key ResponsibilitiesLeadership, Culture & Accountability (Primary Emphasis)

• Lead, inspire, and develop hospital insurance A/R and denial management teams through clear expectations, coaching, and performance management.
• Build a high-accountability culture focused on results, quality, compliance, and continuous improvement.
• Establish clear roles, productivity standards, and quality benchmarks for managers, supervisors, and staff.
• Conduct regular performance reviews, corrective action, and succession planning for key revenue cycle roles.
• Serve as a trusted leader and subject matter authority for hospital insurance reimbursement and payer strategy.

Hospital Insurance A/R & Denials Strategy

• Own end-to-end performance of hospital insurance accounts receivable, with direct accountability for AR days, aging, and collections.
• Lead denial prevention, management, and appeals strategy across Medicare, Medicaid, commercial, managed care, and governmental payers.
• Direct resolution of high-risk, high-dollar, and complex hospital claims requiring escalation or negotiation.
• Identify payer trends and root causes impacting reimbursement and drive corrective action plans.

Payer Relations & Executive Communication

• Serve as the primary escalation point for payer disputes, underpayments, and systemic reimbursement issues.
• Lead payer strategy discussions and represent the organization in payer meetings and negotiations.
• Translate operational performance into executive-level insights, risks, and recommendations.

Cross-Functional Leadership & Collaboration

• Partner with Coding, CDI, Utilization Review, Case Management, Registration, Compliance, and IT leaders to improve insurance reimbursement outcomes.
• Lead cross-functional initiatives to reduce preventable denials and improve first-pass resolution.
• Influence stakeholders without direct authority to drive enterprise-wide revenue cycle improvement.

Financial Performance & Reporting

• Establish and monitor hospital insurance revenue cycle KPIs, including AR aging, denial rates, appeal success, and insurance cash.
• Hold leaders and teams accountable for meeting performance targets through data-driven action plans.
• Support budgeting, forecasting, and strategic planning related to hospital reimbursement and cash flow.

Compliance, Risk & Audit Oversight

• Ensure insurance follow-up and appeals processes comply with CMS, payer contracts, and state and federal regulations.
• Maintain audit-ready documentation and lead teams through internal and external audits.
• Proactively identify compliance risks and implement corrective action plans.

Physician Billing Insurance Oversight (Secondary)

• Provide leadership oversight for physician/professional insurance A/R to ensure alignment with hospital payer strategies.
• Monitor denial trends and payer behavior across professional billing to drive consistent enterprise standards.

Qualifications
Required

• Bachelor’s degree in healthcare administration, Business, Finance, or related field (or equivalent experience).
• 7+ years of progressive revenue cycle experience with significant hospital insurance A/R leadership responsibility.
• Demonstrated success leading teams responsible for hospital collections, denials, and appeals.
• Strong working knowledge of hospital reimbursement methodologies and payer regulations.

Leadership Competencies

• Proven people leader with the ability to motivate, develop, and retain high-performing teams
• Decisive, accountable, and results-driven leadership style
• Strong executive presence and communication skills
• Strategic thinker with the ability to translate data into action