Job ID: Revenue Cycle Manager
Position Type: Full Time
Reports To: Chief Executive Officer (CEO)
Position Summary
Essential Duties and Responsibilities
Revenue Cycle Operations
- Oversee the complete revenue cycle from patient registration through final payment.
- Develop, implement, and monitor revenue cycle policies and procedures.
- Ensure accurate and timely billing of all physician and ancillary services.
- Monitor charge capture processes to ensure services are billed appropriately and promptly.
- Optimize reimbursement while maintaining compliance with payer and regulatory requirements.
- Identify opportunities to improve revenue, reduce denials, and streamline workflows.
Billing & Accounts Receivable
- Supervise billing staff responsible for claim submission, payment posting, and collections.
- Monitor Accounts Receivable (A/R) aging and establish goals for timely collections.
- Review payer trends and implement corrective action plans to reduce aging balances.
- Oversee denial management, appeals, and underpayment recovery efforts.
- Monitor collection rates, days in A/R, first-pass claim acceptance, clean claim rate, and bad debt.
Coding & Compliance
- Partner with certified coders to ensure accurate CPT, ICD-10, HCPCS, and modifier usage.
- Ensure compliance with CMS, Medicare, Medicaid, commercial payer, OSHA, HIPAA, and applicable federal and state regulations.
- Coordinate internal coding audits and corrective education.
- Stay current on payer policies, coding updates and reimbursement changes.
Financial Performance
- Prepare monthly revenue cycle reports and present key performance indicators to executive leadership.
- Analyze reimbursement trends by provider, location, payer, and service line.
- Develop action plans to improve financial performance and operational efficiencies.
- Assist with budgeting, forecasting, and revenue projections.
Leadership & Staff Development
- Directly supervise billing, collections, payment posting, insurance verification, and other revenue cycle personnel.
- Recruit, train, mentor, and evaluate staff performance.
- Establish productivity standards and accountability measures.
- Conduct regular team meetings and ongoing education.
Payer Relations
- Maintain positive working relationships with commercial insurance carriers, Medicare, Medicaid, workers' compensation carriers, and third-party administrators.
- Resolve escalated payer disputes and reimbursement issues.
- Assist leadership with payer contract implementation and operational impacts.
Cross-Department Collaboration
- Work closely with physicians, practice administrators, surgery scheduling, clinical staff, coding, and front office teams.
- Improve communication between departments to reduce billing errors and improve patient satisfaction.
- Support implementation of new services, providers, and technology affecting revenue cycle operations.
Qualifications
Education
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field preferred.
- Equivalent experience considered.
Experience
- Minimum of 5 years of progressive revenue cycle management experience.
- Minimum of 3 years in a leadership or management role.
- Experience within surgical, multispecialty, or physician practice strongly preferred.
- Experience managing high-volume physician billing operations.
Preferred Certifications
- Certified Revenue Cycle Representative (CRCR)
- Certified Professional Coder (CPC)
- Certified Professional Medical Auditor (CPMA)
- Certified Healthcare Financial Professional (HFMA)
Knowledge, Skills & Abilities
- Extensive knowledge of physician billing and reimbursement.
- Strong understanding of surgical coding and reimbursement.
- Detailed knowledge of Medicare, Medicaid, commercial insurance, workers' compensation, and personal injury billing.
- Experience with EHR and practice management systems.
- Advanced Microsoft Excel and reporting skills.
- Strong analytical and financial management abilities.
- Excellent leadership, communication, and organizational skills.
- Ability to manage multiple priorities in a fast-paced healthcare environment.
- Strong problem-solving and decision-making skills.
- High level of professionalism, integrity, and confidentiality.
Physical Requirements
- Prolonged periods of sitting and computer work.
- Occasional standing, walking, and lifting up to 20 pounds.
- Ability to communicate effectively in person, by telephone, and electronically.
Work Environment
- Professional medical office environment.
- Standard business hours with occasional extended hours as needed to meet operational demands.
Benefits
- Competitive salary
- Medical, Dental, and Vision Insurance
- Paid Time Off
- Paid Holidays
- 401(k) with employer match
This position plays a critical leadership role in maximizing the financial health of the practice while ensuring compliance, operational excellence, and an exceptional patient financial experience. The Revenue Cycle Manager is expected to foster a culture of accountability, continuous improvement, and collaboration across all revenue-generating functions of the organization.