Revenue Cycle Manager

Job Type


Full-time

Description

The Revenue Cycle Manager (RCM) leads all billing, coding, claims submission, denial management, and accounts receivable functions for Summit Surgical. Operating as both a working manager and a strategic leader, the RCM oversees a team of billing and coding specialists while maintaining direct accountability for the facility's net revenue capture, payer compliance, and financial reporting accuracy.

Responsibilities:

Revenue Cycle Operations

• Oversee end-to-end revenue cycle: patient registration, prior authorization, charge capture, coding review, claims submission, payment posting, denial management, and A/R follow-up, payer contract and relationship management,
• Ensure timely and accurate claim submission to Medicare, Medicaid, and all commercial payers in compliance with CMS and payer-specific guidelines
• Maintain clean claim rate target of =95% and monitor days in A/R against facility benchmarks
• Manage and optimize TruBridge billing and coding modules; identify workflow improvement opportunities
• Maintain charge description master (CDM) integrity and accuracy of payer fee schedules

Coding & Compliance

• Review and audit surgical, anesthesia, and facility coding for accuracy under ICD-10-CM/PCS, CPT, and HCPCS Level II guidelines
• Maintain HIPAA billing compliance and adhere to OIG compliance program requirements
• Serve as primary liaison with Summit physicians and clinical staff on clinical documentation improvement and charge capture accuracy
• Monitor and implement regulatory updates from CMS, OIG, and AAPC

Financial Reporting & Analysis

• Produce weekly, monthly, and quarterly revenue cycle performance dashboards for FenixMed leadership and Summit ownership
• Track and report key metrics: days in A/R, denial rate, clean claim rate, cash collections, write-off ratios, and net collection rate
• Lead root-cause analysis on denial trends and underpayments; develop and execute corrective action plans
• Coordinate with FenixMed accounting team for month-end close, contractual adjustments, and bad debt reserve calculations

Team Leadership & Development

• Recruit, hire, onboard, and develop billing and coding specialists
• Set individual performance goals, provide regular coaching, and conduct annual performance reviews
• Create and maintain billing and coding policy and procedure documentation
• Coordinate continuing education and support certification maintenance for team members

Payer & Vendor Relations

• Manage payer contracts, credentialing timelines, and provider enrollment in coordination with FenixMed
• Serve as primary escalation contact for complex claim disputes and payer audits
• Evaluate and recommend billing technology tools, clearinghouses, or supplemental coding resources as needed

Requirements

Education:

Bachelor's degree in Health Information Management, Business Administration, Healthcare Administration, or related field required

Equivalent combination of education and directly related experience may be considered

Licensure:

No licensure required for this position

Certification:

• Preferred:
• Active coding or billing certification from AAPC or AHIMA
• Certified Professional Coder (CPC) - AAPC
• Certified Outpatient Coder (COC) - AAPC; preferred for surgical/ASC environment
• Certified Coding Specialist (CCS) - AHIMA
• Certified Healthcare Financial Professional (CHFP) - HFMA
• Annual certification maintenance stipend provided ($500-$1,000)

Experience:

• Minimum 5 years of progressive healthcare revenue cycle experience required
• Minimum 2 years in a supervisory, lead, or management role required
• Direct experience in a hospital, ambulatory surgery center, or physician-owned surgical facility required
• Experience with EHR/PM billing modules required; TruBridge (Netsmart) experience strongly preferred
• Experience managing a transition from outsourced to in-house revenue cycle operations preferred
• Familiarity with Kansas Medicaid (KanCare) and regional commercial payer requirements preferred

Skills:

• Proficiency with ICD-10-CM/PCS, CPT, HCPCS Level II, and modifier application in surgical settings
• Working knowledge of Medicare, Medicaid, and major commercial payer billing rules and reimbursement methodologies
• Strong data analysis skills; ability to build, interpret, and present A/R and denial management reports
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Teams)
• Excellent written and verbal communication skills; ability to translate financial data for clinical and executive audiences
• Demonstrated accountability, integrity, and ability to manage competing priorities in a fast-moving environment

Work Schedule:

Regular schedule is Monday - Friday, 8:00 am to 5:00 pm