Senior Manager of Front-End RCM Operations

The Senior Manager of Front-End RCM Operations leads the end-to-end patient access, financial clearance, coding, and charge entry functions with primary focus areas including insurance verification, medical necessity review, prior authorizations, patient financial communication, coding accuracy, and charge capture. This role ensures timely and accurate data entry, proper coding, compliant charge posting, and clean claim generation to minimize denials, accelerate reimbursement, and support an optimal patient experience. The leader drives team performance, optimizes workflows, implements policy and system enhancements, and collaborates cross-functionally across clinical, billing, and RCM departments to support organizational revenue goals.

Essential Duties and Responsibilities:

• Establishes department goals focused on turnaround time, accuracy, first-pass approval rates, and clean claim rates.
• Partners with Human Resources to develop staffing models, training plans, productivity standards, and KPI dashboards across all front-end, coding, and charge entry functions.
• Promotes a performance-driven culture focused on accuracy, compliance, timeliness, and patient experience.
• Partners with clinical leaders to ensure documentation completeness for timely payer review and accurate charge capture.
• Oversees daily coding and charge entry operations to ensure timely, accurate, and compliant posting.
• Ensures encounter forms, provider documentation, and clinical notes are complete and accurate for coding and charge posting.
• Oversees coding workflows including CPT, ICD-10, and HCPCS accuracy in alignment with payer rules and compliance standards.
• Collaborates with Providers, Coders, Billing, and Clinical teams to resolve coding discrepancies, missing charges, documentation gaps, and clearinghouse edits.
• Monitors charge lag, coding turnaround time, reconciliation workflows, and missing charge queues to support clean claims and timely billing.
• Develops and implement standardized SOPs, policies, and audit processes for front end, coding and charge entry.
• Partners with Coding leadership (or serves as the coding lead where applicable) to ensure regulatory compliance and ongoing coder/provider education.
• Works with IT and system administrators to optimize coding templates, charge entry workflows, automation tools, and system configurations.
• Serves as the primary liaison for external vendors supporting eligibility, authorization, patient access, coding, or charge entry functions.
• Leads vendor selection, onboarding, implementation, and ongoing performance evaluation.
• Monitors vendor performance against SLAs and compliance standards.
• Recommends optimizations to improve results, quality, and efficiency.
• Oversees accuracy and timeliness of scheduling, demographic entry, insurance verification, benefit checks, and financial counseling.
• Ensures prior authorizations are obtained for all required procedures and payers.
• Collaborates with billing, coding, and collections to resolve front-end errors that impact claim submission and reimbursement.
• Utilizes system tools (e.g., eligibility checks, authorization dashboards, charge capture worklists) to identify and correct data gaps.
• Maintains compliance with federal and state regulations, industry standards, and payer policies.
• Performs quality audits on registration accuracy, authorization documentation, coding accuracy, and charge posting.
• Supports ongoing staff and provider education on coding rules, payer requirements, and documentation standards.
• Tracks and report KPIs including registration accuracy, authorization turnaround time, coding accuracy, charge lag, POS collections, and eligibility denials.
• Analyzes trends and collaborate with IT and RCM leadership to enhance workflows and system configurations.
• Leads or participate in cross-functional revenue cycle improvement initiatives.
• Provides data-driven insights to improve operational efficiency, coding compliance, and patient access metrics.
• Checks and responds to work e-mail on a regular basis throughout the workday.
• Participates in and complete all required trainings and in-services.
• Other duties as assigned.

Minimum Qualifications:

• Bachelor's degree in healthcare administration, business, or a related field of study WITH five (5) years of experience in Revenue Cycle Management with direct oversight of pre-certification, authorization, coding, or charge entry teams; OR an equivalent combination of education and/or experience.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Must have strong, demonstrated experience with EHR/PM systems.
• Must have excellent written and oral communication skills, including exceptional customer service.
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
• Must be able to work individually as well as within a team.
• Must be able to follow both verbal and written instructions.
• Must be able to work a flexible schedule.
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
• Must be able to multi-task and prioritize.
• Must demonstrate extreme attention to detail.
• Must possess strong organization skills.
• Must be able to problem solve and use reasoning.
• Must be able to meet predefined quality standards.
• Must maintain and project a professional attitude and appearance at all time.
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
• Must possess strong leadership skills and be able to effectively manage and direct others.
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Experience with Athenahealth or similar EHR/PM systems
• Coding Certification (e.g.: CPC, CCS, RHIT).
• Experience managing third-party revenue cycle vendors.

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee's home, work assignments could be in any of the Company's locations.

Compensation and Benefits:

• Pay Range: $105,000/Year - $115,000/year
• PTO: Up to 120 hours in first year (pro-rated based on start date)
• Holidays: 7 (New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement: 401(k) with employer match
• Health Benefits: Medical (single and family), Dental (single and family), Vision (single and family)
• Other Company-Paid Benefits: Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
• Other Voluntary Benefits: Voluntary Life, Accident, Critical Illness, Hospital Indemnity