Manager of Patient Access & Revenue Operations

Job Description

Job Description

MANAGER OF PATIENT ACCESS & REVENUE OPERATIONSPosition Summary

The Manager of Patient Access & Revenue Operations is responsible for overseeing operational performance across patient access and revenue cycle functions to ensure efficient patient intake, accurate financial clearance, compliant billing practices, and optimal reimbursement.

This role provides leadership and oversight across front-end, middle-cycle, and back-end revenue cycle operations including scheduling, eligibility verification, prior authorization, charge entry, billing, payment posting, accounts receivable follow-up, and patient financial services. The Manager works collaboratively with clinical, operational, and finance leadership to improve revenue integrity, operational efficiency, and patient experience.

Duties and ResponsibilitiesPatient Access & Call Center Operations

• Oversee call center, scheduling, and patient registration workflows.
• Ensure accurate patient demographic capture and scheduling processes.
• Monitor call center performance including service levels and patient experience.
• Ensure timely patient access and efficient scheduling operations.

Eligibility & Financial Clearance

• Oversee insurance eligibility verification and benefits validation.
• Ensure prior authorization and referral processes are completed prior to services.
• Support financial counseling and patient responsibility communication.
• Monitor financial clearance processes to prevent billing delays and denials.

Point-of-Service Collections

• Oversee point-of-service collection processes and patient financial estimates.
• Ensure consistent collection practices and financial counseling.
• Monitor patient payment plan enrollment and patient balance management.

Medical Records Coordination

• Oversee medical records workflow and documentation coordination.
• Ensure timely chart completion to support charge capture and billing.
• Maintain compliance with documentation and release-of-information policies.

Credentialing & Enrollment Oversight

• Oversee provider credentialing and payer enrollment processes.
• Ensure accurate CAQH maintenance and payer portal management.
• Monitor enrollment timelines to prevent claim submission delays.

Charge Entry & Coding Operations

• Oversee charge capture and professional charge entry processes.
• Ensure coding accuracy and compliance with payer requirements.
• Monitor charge lag and support timely charge entry.

Claim Submission & Billing

• Oversee claim preparation, claim scrubbing, and submission workflows.
• Ensure claims are submitted timely and accurately according to payer guidelines.
• Monitor claim edits and system workflows to support clean claim submission.

Payment Posting & Reconciliation

• Oversee ERA and manual payment posting processes.
• Ensure payment reconciliation accuracy.
• Identify and escalate payer payment variances.

Accounts Receivable & Denial Management

• Manage insurance accounts receivable and denial resolution processes.
• Monitor payer trends and implement corrective actions to reduce denials.
• Support timely follow-up on unpaid claims.

Patient Financial Services

• Oversee patient balance collections and refund processes.
• Manage early-out vendors and bad debt placement processes.
• Ensure compliance with refund policies and patient financial regulations.

Revenue Integrity

• Monitor charge capture accuracy and revenue reconciliation.
• Identify revenue leakage and implement operational improvements.
• Support revenue cycle performance monitoring and reporting.

Performance Accountability / Key Performance IndicatorsPatient Access

• Speed to answer
• Call abandonment rate
• First-call resolution rate

Scheduling & Access

• Scheduling accuracy
• Patient access timeliness

Financial Clearance

• Eligibility verification accuracy
• Authorization accuracy rate

Point-of-Service Collections

• POS collection rate
• Estimate-to-collection conversion rate

Registration Quality

• Registration-related denial rate

Staff Performance

• Staff productivity metrics
• Quality assurance monitoring

Charge Capture

• Charge entry accuracy rate
• Charge entry timeliness

Billing Performance

• Claim rejection and edit rate
• First-pass claim acceptance rate
• Claim submission timeliness

Revenue Cycle Quality

• Rework or correction rate
• Denial rate and resolution turnaround time

Qualifications and SkillsEducation

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field preferred.

Experience

• Minimum of five (5) years of experience in healthcare revenue cycle or patient access operations.
• Minimum of two (2) years of leadership or supervisory experience.
• Experience working in a physician practice or specialty clinic preferred.
• Experience with AthenaOne, NextGen, eClinicalWorks, or similar practice management systems preferred.

Knowledge & Skills

• Comprehensive knowledge of healthcare revenue cycle operations including patient access, charge capture, billing, payment posting, accounts receivable, and patient financial services.
• Strong understanding of patient access workflows including scheduling, registration, eligibility verification, and prior authorization processes.
• Knowledge of payer reimbursement methodologies including Medicare, Medicaid, and commercial insurance plans.
• Familiarity with CPT, HCPCS, and ICD-10 coding fundamentals and claim submission requirements.
• Understanding of point-of-service collections, patient financial counseling, and insurance benefit structures.
• Ability to lead and develop operational teams across patient access and revenue cycle functions.
• Strong analytical skills with the ability to interpret revenue cycle performance metrics and operational data.
• Experience utilizing healthcare EMR and practice management systems (e.g., AthenaOne, eClinicalWorks, NextGen) and payer portals.
• Knowledge of healthcare compliance requirements including HIPAA, documentation standards, and billing regulations.
• Strong communication, collaboration, and problem-solving skills to support cross-functional operational improvement.

Working Conditions

• Work area must protect the confidentiality of the work the employee is performing.
• Regular use of office equipment.

Physical Requirements

• Extensive and regular periods of sitting, standing, bending, walking, seeing, talking, and listening.
• A full range of body motion including complete manual and finger dexterity, as well as effective hand-eye coordination.
• Adequate visual acuity including the ability to read information.
• Occasional requirement to reach with hands/arms, stoop, kneel, or crouch.
• Occasional requirement to push, pull, lift, and/or move up to 10 pounds.

Reports To: Executive Director

FLSA Status: Exempt

Location: On-Site with Multi-Location Support

Disclaimer: This job description summarizes the primary duties of the position and is not intended to be all-inclusive. Duties may change at management's discretion.