Revenue Cycle Manager

Revenue Cycle Manager

The Revenue Cycle Manager oversees the practice's complete revenue cycle, from patient registration and insurance verification through billing, collections, and final payment. This position is responsible for maximizing reimbursement, reducing denials and A/R, ensuring billing and coding compliance, and improving revenue cycle efficiency. The Manager leads revenue cycle staff and collaborates with physicians, clinical teams, front office staff, and payers to support the financial performance of the practice and a positive patient financial experience.

Revenue Cycle Management

• Oversee all front-end and back-end revenue cycle functions, including registration, insurance verification, authorizations, charge capture, coding, billing, payment posting, A/R, denials, and collections.
• Develop and maintain revenue cycle policies, procedures, and workflows.
• Monitor billing accuracy, timely claim submission, reimbursement, and collections.
• Identify opportunities to improve processes, increase revenue, and reduce billing errors and denials.

Billing & A/R

• Supervise billing, collections, payment posting, and related revenue cycle functions.
• Monitor A/R aging and establish collection and productivity goals.
• Oversee denial management, appeals, and underpayment recovery.
• Monitor key performance indicators, including A/R days, collection rates, denial rates, and clean claim rates.

Coding & Compliance

• Partner with coding staff to ensure accurate CPT, ICD-10, HCPCS, and modifier usage.
• Ensure compliance with Medicare, Medicaid, commercial payers, workers' compensation, HIPAA, CMS, and applicable federal and state regulations.
• Coordinate coding and billing audits and implement corrective action when needed.
• Monitor changes in payer policies, coding requirements, and reimbursement regulations.

Financial Reporting

• Prepare and present revenue cycle reports and performance metrics to leadership.
• Analyze reimbursement and collection trends by provider, location, and payer.
• Develop action plans to improve financial performance.
• Assist with budgeting, forecasting, and revenue projections.

Leadership

• Hire, train, supervise, and evaluate revenue cycle staff.
• Establish productivity standards and promote accountability and continuous improvement.
• Conduct team meetings and provide ongoing training and education.
• Collaborate with physicians, practice administration, surgery scheduling, clinical staff, coding, and front office teams to resolve revenue cycle issues.
• Maintain effective relationships with insurance companies and other third-party payers and assist with escalated reimbursement issues.

Qualifications

Education & Experience

• Bachelor's degree in Healthcare Administration, Business, Finance, Accounting, or related field preferred; equivalent experience may be considered.
• Minimum of 5 years of progressive medical revenue cycle experience.
• Minimum of 3 years of management or supervisory experience.
• Physician practice, orthopedic, surgical, or multispecialty experience preferred.
• Experience managing high-volume physician billing operations strongly preferred.

Knowledge, Skills & Abilities

• Strong knowledge of physician billing, reimbursement, coding, and A/R management.
• Knowledge of Medicare, Medicaid, commercial insurance, workers' compensation, and other payer requirements.
• Proficiency with EHR/practice management systems and Microsoft Excel.
• Strong analytical, financial, organizational, and problem-solving skills.
• Excellent leadership and communication skills.
• Ability to manage multiple priorities in a fast-paced medical practice.
• High level of professionalism, confidentiality, and integrity.

Preferred Certifications: CRCR, CPC, CPMA, or HFMA certification preferred.

Physical & Work Requirements

• Primarily office-based with prolonged periods of sitting and computer use.
• Ability to communicate effectively in person, by phone, and electronically.
• Occasional standing, walking, and lifting up to 20 pounds.
• Occasional extended hours may be required based on operational needs.

Benefits

• Competitive salary
• Medical, Dental, and Vision Insurance
• Paid Time Off
• Paid Holidays
• 401(k) with Employer Match